Objective: To identify determinants of malnutrition in a consecutively selected cohort of children undergoing corrective surgery or catheter intervention for congenital heart disease (CHD) in a center in the developing world and examine the impact of corrective intervention on nutritional recovery.
Methods: Patients with CHD admitted for corrective intervention were evaluated for nutritional status before and 2 years after the procedure. Anthropometric measurements were obtained at presentation and at 6-month intervals and Z-scores calculated. Malnutrition was defined as weight-for-age, height-for-age and weight/height Z-score < -2. Determinants of malnutrition were entered into a multivariate logistic regression analysis model.
Results: 476 consecutive children (mean age: 15.2 + 16.2 months) undergoing corrective intervention were included. Weight Z-score <-2 was found in 59%; 26.3% had height Z-score
<-2 at presentation. Predictors of malnutrition at presentation included congestive heart failure (CHF), age at correction, birth weight and parental height. On follow-up (425 patients; duration 20.63 + 13.1 months), there was significant improvement in the Z-scores for weight (-2.19 + 1.16 vs. -1.42 + 1.03; p<0.001) and weight/height (-2.09 + 1.3 vs. -1.15 + 1.25; p< 0.001). Height Z-scores remained unchanged(Figure-1). Malnutrition persisted in 116 (27.3%) on follow-up and was predicted by birth weight, nutritional status at presentation and parental height. Cardiac diagnosis, dietary intake and socio-economic factors did not impact malnutrition.
Conclusions: Significant malnutrition is common in patients with CHD and is reversible once corrective intervention is performed. Persistent malnutrition after corrective intervention is predicted by nutritional status at presentation, birth weight and parental anthropometry.