Abstract
Background
Malnutrition (undernutrition) in children with congenital disease (CHD) is a notable concern, with preoperative and persistent growth failure post-cardiac surgery contributing to poorer outcomes. Poor growth in children with CHD in low-income environments is exacerbated by feeding difficulties, poverty, delayed diagnosis, and late corrective surgery. This study describes and compares the growth of young children with CHD undergoing cardiac surgery in central South Africa from before to 6-months after cardiac surgery.
Methods
Children 30 months and younger, with their mothers, were included in this prospective observational descriptive study. Weight- height-, and head circumference-for-age z-scores were used to identify children who were underweight, stunted and microcephalic. Z-scores for growth indices were compared from baseline to 3-months and 6-months post-cardiac surgery. Changes in growth over time were calculated using a 95% confidence interval on the difference between means. Linear regression was used to determine the association between growth and development, health-related quality of life and parenting stress respectively.
Results
Forty mother-child pairs were included at baseline. Most children (n = 30) had moderate disease severity, with eight children having cyanotic defects. A quarter of the children had Down syndrome (DS). Twenty-eight children underwent corrective cardiac surgery at a median age of 7.4 months. Most children (n = 27) were underweight before cardiac surgery [mean z-score − 2.5 (±1.5)], and many (n = 18) were stunted [mean z-score − 2.2 (±2.5)]. A quarter (n = 10) of the children had feeding difficulties. By 6-months post-cardiac surgery there were significant improvements in weight (p = 0.04) and head circumference (p = 0.02), but complete catch-up growth had not yet occurred. Malnutrition (undernutrition) was strongly associated (p = 0.04) with poorer motor development [Mean Bayley-III motor score 79.5 (±17.5)] before cardiac surgery. Growth in children with cyanotic and acyanotic defects, and those with and without DS were comparable.
Conclusion
Malnutrition (undernutrition) is common in children with CHD in central South Africa, a low-income environment, both before and after cardiac surgery, and is associated with poor motor development before cardiac surgery. A diagnosis of CHD warrants regular growth monitoring and assessment of feeding ability. Early referral for nutritional support and speech therapy will improve growth outcomes.
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.
