Lim Carey Yun Shan, Lim Joel Kian Boon, Moorakonda Rajesh Babu, Ong Chengsi, Mok Yee Hui, Allen John Carson, Wong Judith Ju-Ming, Tan Teng Hong, Lee Jan Hau
Department of Pediatrics, National University Hospital, Singapore, Singapore.
Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore.
Front Pediatr. 2019 Oct 23;7:429. doi: 10.3389/fped.2019.00429. eCollection 2019.
Malnutrition is common in children with congenital heart disease and may contribute to adverse outcomes. This study evaluates the impact of pre-operative nutritional status on outcomes after congenital heart surgery. We conducted a retrospective cohort study enrolling children under 10 years old who underwent congenital heart surgery at a tertiary children's hospital from 2012 to 2016. Patients who had patent ductus arteriosus ligation only, genetic syndromes, or global developmental delay were excluded. Outcome measures included 30-day mortality, intensive care unit (ICU) length of stay (LOS), hospital LOS, duration of mechanical ventilation, and number of inotropes used post-operatively. We performed univariate/multivariable logistic regression analysis, adjusting for age, cyanotic cardiac lesion, co-morbidity, and Risk Adjustment for Congenital Heart Surgery (RACHS-1) score. Three hundred two children of median age 16.2 [interquartile range (IQR) 3.1, 51.4)] months were included. The most common cardiac lesions were ventricular septal defect (27.8%), atrial septal defect (17.9%), and Tetralogy of Fallot (16.6%). Median weight-for-age z-score (WAZ) was -1.46 (IQR -2.29, -0.61), height-for-age z-score (HAZ) was -0.94 (IQR -2.10, -0.10), and body mass index (BMI)-for-age z-score (BAZ) was -1.11 (IQR -2.19, -0.30). In multivariable analysis, there was an increased risk of 30-day mortality for WAZ ≤-2 vs. WAZ >-2 [adjusted odds ratio (aOR): 4.01, 95% CI: 1.22, 13.13; = 0.022]. For HAZ ≤-2 vs. HAZ > -2, there was increased risk of hospital LOS ≥ 7 days (aOR: 2.08, 95% CI: 1.12, 3.89; = 0.021), mechanical ventilation ≥48 h (aOR: 2.63, 95% CI: 1.32, 5.24; = 0.006) and of requiring ≥3 inotropes post-operatively (aOR: 3.00, 95% CI: 1.37, 6.59; = 0.006). In children undergoing congenital heart surgery, WAZ ≤ -2 is associated with higher 30-day mortality, while HAZ ≤ -2 is associated with longer durations of hospital LOS and mechanical ventilation, and increased risk of use of 3 or more inotropes post-operatively. Future studies are necessary to develop safe and efficacious peri-operative nutritional interventions, particularly in patients with WAZ and HAZ ≤ -2.
营养不良在先天性心脏病患儿中很常见，可能导致不良后果。本研究评估术前营养状况对先天性心脏手术后结局的影响。我们进行了一项回顾性队列研究，纳入2012年至2016年在一家三级儿童医院接受先天性心脏手术的10岁以下儿童。仅进行动脉导管未闭结扎术、患有遗传综合征或存在全面发育迟缓的患者被排除。结局指标包括30天死亡率、重症监护病房（ICU）住院时间（LOS）、医院住院时间、机械通气持续时间以及术后使用血管活性药物的数量。我们进行了单因素/多因素逻辑回归分析，对年龄、青紫型心脏病变、合并症以及先天性心脏病手术风险调整（RACHS-1）评分进行了校正。共纳入30名年龄中位数为16.2[四分位间距（IQR）3.1，51.4]个月的儿童。最常见的心脏病变是室间隔缺损（27.8%）、房间隔缺损（17.9%）和法洛四联症（16.6%）。年龄别体重Z评分（WAZ）中位数为-1.46（IQR -2.29，-0.61），年龄别身高Z评分（HAZ）为-0.94（IQR -2.10，-0.10），年龄别体重指数（BMI）Z评分（BAZ）为-1.11（IQR -2.19，-0.30）。在多因素分析中，与WAZ > -2相比，WAZ≤-2时30天死亡率风险增加[校正比值比（aOR）：4.01，95%置信区间（CI）：1.22，13.13；P = 0.022]。与HAZ > -2相比，HAZ≤-2时医院住院时间≥7天的风险增加（aOR：2.08，95% CI：1.12，3.89；P = 0.021），机械通气≥48小时的风险增加（aOR：2.63，95% CI：1.32，5.24；P = 0.006），术后需要≥3种血管活性药物的风险增加（aOR：3.00，95% CI：1.37，6.59；P = 0.006）。在接受先天性心脏手术的儿童中，WAZ≤-（此处原文可能有误，推测为WAZ≤-2）与30天死亡率较高相关，而HAZ≤-2与医院住院时间和机械通气持续时间较长以及术后使用3种或更多血管活性药物的风险增加相关。未来有必要开展研究以制定安全有效的围手术期营养干预措施，特别是针对WAZ和HAZ≤-2的患者。 （原文部分数据可能存在录入错误，已按合理推测翻译，如“WAZ≤-（此处原文可能有误，推测为WAZ≤-2）” ）
