Nutritional assessment of children with congenital heart diseases in the Pediatric Cardiology Clinic, Pediatric Hospital, Ain Shams University

Abstract

Children and infants with congenital heart disease (CHD) often have disturbances in growth and development. Failure to thrive is well recognized as a serious problem in those children. Recent research suggests that this is mainly due to inadequate caloric intake and increased energy expenditure as compared to normal children. This presents a significant problem because if left untreated, these children can develop permanent disabilities and poorer outcomes after corrective surgery. Due to the differences between congenital cardiac lesions and the mechanisms by which they retard growth, no single strategy will be adequate to treat all cases. So, in order to treat this problem, a systematic approach must be used to identify the specific reasons for this failure to thrive, to develop a strategy for a structured feeding program, and to educate parents as to the best ways to feed their children. The present study was designed to assess the nutritional status of infants and children with congenital heart defects and to identify the prevalence of malnutrition in those patients. The present study was carried out at the children hospital, Faculty of medicine, Ain Shams University. It included 152 infants and children with congenital heart defects,77(50.4%) were males and 75(49.6%) were females, their weights ranged from 2.3kg to 18kg with a median and IQR of 8.5 (5.5-11.5kg) and a mean and SD of(8.43.5kg). All patients were subjected to full history taking laying stress on their ages, gender, anthropometric measurements, type of congenital heart disease, presence or absence of cardiac complications and operative intervention, type of feeding, dietary adequacy in relation to the recommended daily allowance of different food staff according to nutritional tables and complete blood count. CHD was diagnosed by transthoracic echocardiography. In the current study, the overall prevalence of undernutrition (diagnosed as WAZ score ≤ 2) was found to be present in 65.8% of patients, Stunting (HAZ score ≤ 2) was found to be present in 66.4% of patients while Wasting (WHZ score ≤ 2) was present in 62.5% of the studied population. In the present study, undernutrition, wasting and stunting were more common in the cyanotic group (74.4%, 62.8%, 25.6%)respectively when compared to the acyanotic group (63.3%, 49.5%, 18.3%) respectively. This difference was statistically significant and can be explained by exposure to chronic hypoxemia which causes a poor growth in patients with cyanotic congenital heart diseases. In the present study, undernutrition and stunting were more common in non-operated patients with CHD (56.2%, 77.4%) respectively than in patients with corrective interventions (41.9%, 63.6%) respectively. This difference was statistically significant. Regarding wasting, there was no statistically significant difference between its prevalence among the non-operated (20.7%) when compared to the operated patients (19.4%).This can be explained by the prolonged exposure to the hemodynamic impairment due to the delay in the corrective interventions in those patients. In the current study ,patients complicated with CHF or pulmonary hypertension were more prone to malnutrition, wasting and stunting (54%, 21%, 76.47%) respectively than patients not suffering from complication(33.3%, 8.3%, 62.5%)respectively. The difference in the percentages between both groups was statistically significant and this is mostly due to the relative increased nutrient requirements caused by increased metabolism, tissue hypoxia and peripheral acidosis, cardiac insufficiency, intestinal malobsorption in patients complicated with CHF or pulmonary hypertension. In the current study, 60.5% of the studied population had anemia (Hb concentration below 11gm/dl according toWHO, 2007). This can be explained by the fact that these patients have limited caloric intake or have monotonous food intake with little meat or other sources of dietary iron. In present study, Anemia was found to be more common in the acyanotic group (50%) when compared to the cyanotic group (10.5%). However, in children with cyanotic CHD, the anaemia may have been relative rather than absolute due to their higher haemoglobin levels. The present study revealed that the most frequent source of dietary animal protein among the studied population was milk which was daily eaten by (4.1%) of studied population. Tea was the most common beverages consumed dailyby4.9%of the studied population and Sugar was the most frequent source of energy and was daily consumed by (42.3%) of studied population. This study revealed that the cyanotic group had a statistically significant lower mean value of energy intake (404.696.06kcal) than the acyanotic group (442.3106.8 kcal).Also, the cyanotic group had a statistically significant lower mean values of total protein intake (16.6813,2gm),fat intake(15.58.1 gm)and carbohydrate intake (49.522.1 gm)when compared to the acyanotic group (16.6813.2 gm),( 186.7 gm)and(5524.1 gm)respectively. Furthermore, the complicated acyanotic group had a statistically significant lower mean values of energy intake (322.5697.5 kcal), protein intake (12.76+7.86gm), fat (7.94+5.92gm) and carbohydrate 47.02+18.9gm) when compared to the uncomplicated acyanotic (326.94119.4 kcal), (15.05+8.58gm), (13.549.66gm) and (47.07+23.94gm) respectively