Biomedical

Undernutrition in young children with congenital heart disease undergoing cardiac surgery in a low-income environment

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Smith Robyn,

Smith Robyn

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Ntsiea Veronica,

Ntsiea Veronica

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Brown Stephen,

Brown Stephen

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Potterton Joanne

Potterton Joanne

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Abstract

Key Questions


1. What is the prevalence of malnutrition in children with congenital heart disease (CHD)?

Malnutrition (undernutrition) is highly prevalent in children with CHD, particularly in low-income settings, and often persists before and after cardiac surgery.

2. How does malnutrition impact children with CHD?

Malnutrition is associated with poorer motor development and growth outcomes, both pre- and post-cardiac surgery, and exacerbates complications related to CHD.

3. What interventions can improve growth outcomes in these children?

Regular growth monitoring, assessment of feeding ability, and early referral for nutritional support and speech therapy are essential to address malnutrition in children with CHD.

4. What were the main findings of this study?

The study found significant improvements in weight and head circumference by 6 months post-surgery, though full catch-up growth was not achieved.


Abstract


Background

Malnutrition (undernutrition) in children with congenital heart disease (CHD) is a significant concern. Preoperative and persistent growth failure post-surgery contribute to poor outcomes, particularly in low-income settings, due to feeding difficulties, poverty, delayed diagnosis, and late corrective surgery. This study compares the growth of children with CHD before and 6 months after cardiac surgery in central South Africa.

Methods

Children aged 30 months or younger and their mothers were included in a prospective observational study. Z-scores for weight, height, and head circumference were used to identify underweight, stunted, and microcephalic children. Growth indices were compared from baseline to 3 months and 6 months post-surgery. Associations between growth, motor development, quality of life, and parenting stress were analyzed using linear regression.

Results

Forty mother-child pairs were included. Most children (n=30) had moderate disease severity, and a quarter had Down syndrome. Before surgery, 27 children were underweight (mean z-score -2.5), and 18 were stunted (mean z-score -2.2). By 6 months post-surgery, weight and head circumference significantly improved (p=0.04 and p=0.02, respectively), though full catch-up growth was not achieved. Malnutrition was significantly associated with poorer motor development before surgery (mean Bayley-III motor score 79.5).

Conclusion

Malnutrition is common in children with CHD in low-income settings, both pre- and post-surgery, and is linked to poor motor development. Regular growth monitoring, feeding ability assessment, and early referral for nutritional support and speech therapy are critical to improving outcomes.

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2024-11-17

Doi: http://dx.doi.org/10.1186/s12887-023-04508-x
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