Sekhon Ravneet, Foshaug Rae R, Kantor Paul F, Mansukhani Gitanjali, Mackie Andrew S, Hollander Seth A, Lewis Kylie, Conway Jennifer
Department of Pediatric Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
Department of Pediatric Cardiology, Keck School of Medicine of USC, Children's Hospital Los Angeles, Los Angeles, California, USA.
JPEN J Parenter Enteral Nutr. 2023 Jan;47(1):59-66. doi: 10.1002/jpen.2437. Epub 2022 Aug 24.
Single-ventricle patients require a series of surgeries, with the final stage being the Fontan. This form of circulation results in several long-term complications, but the impact and consequences of nutrition status remain unclear. We sought to evaluate the incidence of malnutrition in Fontan patients and the impact on outcomes.
This study was a retrospective cohort study of children who underwent Fontan surgery between 1997 and 2018. Clinical, demographic, and nutrition data were collected, including weight, height, body mass index (BMI), and their respective z scores (z score for weight-for-age [WAZ], z score for height-for-age [HAZ], and z score for BMI-for-age [BMIZ]) pre-Fontan, at discharge, 6 months, and 1, 5, and 10 years post-Fontan. Malnutrition status was categorized using the American Society for Parenteral and Enteral Nutrition guidelines and the Michigan MTool. Fontan failure was defined as listing for heart transplant or death.
Of the 69 patients, moderate-severe malnutrition occurred at any time point in 11% (n = 8) by WAZ, 16% (n = 11) by HAZ, and 6% (n = 4) by BMIZ. Moderate-severe malnutrition persisted in 6.5%-12.9% at 10 years post-Fontan. Compared with the pre-Fontan period, there was no change in these parameters over time. There was no statistically significant difference in Fontan failure between degrees of pre-Fontan malnutrition.
There is a 6%-16% incidence of moderate-severe malnutrition in Fontan patients. Malnutrition is a condition that remains present in follow-up. There was no association with anthropometric parameters and transplant-free survival. A prospective multi-institutional study is needed to understand the impact of malnutrition on long-term outcomes.
单心室患者需要进行一系列手术，最后阶段是Fontan手术。这种循环形式会导致多种长期并发症，但营养状况的影响和后果仍不明确。我们试图评估Fontan手术患者中营养不良的发生率及其对预后的影响。
本研究是一项对1997年至2018年间接受Fontan手术的儿童进行的回顾性队列研究。收集了临床、人口统计学和营养数据，包括Fontan手术前、出院时、术后6个月以及术后1年、5年和10年的体重、身高、体重指数（BMI）及其各自的z评分（年龄别体重z评分[WAZ]、年龄别身高z评分[HAZ]和年龄别BMI z评分[BMIZ]）。使用美国肠外和肠内营养学会指南以及密歇根MTool对营养不良状况进行分类。Fontan手术失败定义为列入心脏移植名单或死亡。
69例患者中，根据WAZ，11%（n = 8）在任何时间点出现中度至重度营养不良；根据HAZ，16%（n = 11）；根据BMIZ，6%（n = 4）。Fontan手术后10年，中度至重度营养不良持续存在的比例为6.5% - 12.9%。与Fontan手术前相比，这些参数随时间没有变化。Fontan手术前不同程度的营养不良在Fontan手术失败方面没有统计学上的显著差异。
Fontan手术患者中中度至重度营养不良的发生率为6% - 16%。营养不良是随访中持续存在的一种状况。与人体测量参数和无移植生存率没有关联。需要进行一项前瞻性多机构研究来了解营养不良对长期预后的影响。
