Mitting Rebecca, Marino Luise, Macrae Duncan, Shastri Nitin, Meyer Rosan, Pathan Nazima
1Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom. 2Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom. 3Great Ormond Street Hospital, London, United Kingdom. 44Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom.
Pediatr Crit Care Med. 2015 Jun;16(5):448-52. doi: 10.1097/PCC.0000000000000402.
Poor growth is a common complication in infants with congenital heart disease. There has been much focus on low birth weight as having increased risk of adverse outcomes following neonatal heart surgery. In this study, we examined whether preoperative nutritional status, measured by admission weight-for-age z score, was associated with postoperative clinical outcome.
Retrospective case series.
Pediatric Cardiac ICU at the Royal Brompton Hospital.
Neonates undergoing surgery for congenital heart disease. Those undergoing ductus arteriosus ligation alone were excluded. Children with coexisting noncardiac morbidity were excluded. Outcome variables included prevalence of postoperative complications (including sepsis, delayed chest closure, renal impairment, and necrotizing enterocolitis), duration of ventilation, intensive care stay, postoperative mortality, and mortality at 1 year after surgery.
None. Analysis of patient data only.
Two hundred forty-eight neonates fulfilled the entry criteria. Median (interquartile range) age was 7 days (2-15 d), median (interquartile range) weight was 3.3 kg (2.91-3.6 kg), and median weight-for-age z score was -0.77 (-1.44 to 0.01). Twenty-eight children (11%) had a weight-for-age z score of less than -2. There was no evidence that children with lower weight-for-age z score had less severe surgery as measured by the Risk Adjustment for Congenital Heart Surgery 1 score. In multivariable regression analysis, the weight-for-age z at admission had strong correlation with the number of days free of respiratory support (invasive and noninvasive ventilation) at 28 days (p < 0.0001) and with all-cause mortality at 1 year (p = 0.001).
Poor nutritional status as measured by weight-for-age z is associated with adverse short- and long-term outcomes in neonates undergoing surgery for congenital heart disease.
生长发育不良是先天性心脏病患儿常见的并发症。出生体重低被认为会增加新生儿心脏手术后出现不良结局的风险，这一点已备受关注。在本研究中，我们探讨了以入院时年龄别体重Z评分衡量的术前营养状况是否与术后临床结局相关。
回顾性病例系列研究。
皇家布朗普顿医院儿科心脏重症监护病房。
接受先天性心脏病手术的新生儿。仅接受动脉导管结扎术的患儿被排除。合并非心脏疾病的患儿被排除。结局变量包括术后并发症（包括败血症、延迟关胸、肾功能损害和坏死性小肠结肠炎）的发生率、通气时间、重症监护病房住院时间、术后死亡率以及术后1年的死亡率。
无。仅对患者数据进行分析。
248例新生儿符合纳入标准。中位（四分位间距）年龄为7天（2 - 15天），中位（四分位间距）体重为3.3千克（2.91 - 3.6千克），中位年龄别体重Z评分为 - 0.77（-1.44至0.01）。28名儿童（11%）的年龄别体重Z评分低于 - 2。没有证据表明年龄别体重Z评分较低的儿童所接受手术的严重程度低于先天性心脏病手术风险调整1评分所衡量的程度。在多变量回归分析中，入院时的年龄别体重Z评分与28天时无呼吸支持（有创和无创通气）的天数密切相关（p < 0.0001），与术后1年的全因死亡率密切相关（p = 0.001）。
以年龄别体重Z评分衡量的营养状况不佳与接受先天性心脏病手术的新生儿的短期和长期不良结局相关。
