Harvard Medical School Boston MA USA.
Boston Children's Hospital Boston MA USA.
J Am Heart Assoc. 2024 Jul 2;13(13):e032662. doi: 10.1161/JAHA.123.032662. Epub 2024 Jun 27.
High energy requirements and poor feeding can lead to growth failure in patients with ventricular septal defect (VSD), but effects of preoperative malnutrition on surgical outcomes are poorly understood, especially in low-resource settings.
We analyzed a cohort of children <5 years of age undergoing VSD closure at 60 global centers participating in the International Quality Improvement Collaborative for Congenital Heart Disease, 2015 to 2020. We calculated adjusted odds ratios (ORs) for in-hospital death and major infection and adjusted coefficients for duration of intensive care unit stay for 4 measures of malnutrition: severe wasting (weight-for-height score, <-3), moderate wasting (-3<weight-for-height score≤-2), underweight (weight-for-age score, ≤-2), and stunting (height-for-age score, ≤-2) according to World Health Organization Child Growth Standards. Among 10 966 children undergoing VSD closure in the analyzed cohort, 8136 (74%) were membranous VSDs. Median age was 9.6 months (interquartile range, 3.6-12.0), and 4088 (37.3%) had wasting/severe wasting, 5029 (45.9%) had underweight, and 3515 (32.1%) had stunting. There were 4749 (43.3%) children who met the criteria for ≥2 malnutrition categories. Overall, 84 patients (0.8%) died in-hospital, and 199 (1.8%) had major infection. Severe wasting (OR, 3.38 [95% CI, 1.55-7.35]; =0.002), underweight (OR, 6.46 [95% CI, 2.81-14.8]; <0.001), and stunting (OR, 2.73 [95% CI, 1.40-5.34]; =0.003) were independent predictors of mortality. Similar results were observed for infection and duration of intensive care unit stay. Underweight was the strongest predictor of adverse outcomes. Children meeting criteria for all 3 (stunting, wasting, and underweight) had 17.2 times higher odds of mortality (<0.001) than nonmalnourished children.
Malnutrition was associated with mortality, infection, and longer intensive care unit stay in a global cohort of children undergoing VSD closure.
高能量需求和喂养不良可导致室间隔缺损（VSD）患者生长发育不良，但术前营养不良对手术结果的影响知之甚少，尤其是在资源匮乏的环境中。
我们分析了 2015 年至 2020 年期间，60 个全球中心参与国际先天性心脏病质量改进合作的 60 岁以下接受 VSD 闭合手术的患儿队列。我们根据世界卫生组织儿童生长标准，计算了 4 项营养不良指标（严重消瘦（体重身高得分，<-3）、中度消瘦（-3<体重身高得分≤-2）、消瘦（体重年龄得分，≤-2）和发育迟缓（身高年龄得分，≤-2））的院内死亡和主要感染的调整比值比（OR），以及重症监护病房（ICU）停留时间的调整系数。在分析的队列中，10966 例接受 VSD 闭合的患儿中，8136 例（74%）为膜部 VSD。中位年龄为 9.6 个月（四分位间距，3.6-12.0），4088 例（37.3%）存在消瘦/严重消瘦，5029 例（45.9%）消瘦，3515 例（32.1%）发育迟缓。有 4749 例（43.3%）患儿符合≥2 种营养不良类别的标准。总的来说，84 例（0.8%）患儿院内死亡，199 例（1.8%）发生严重感染。严重消瘦（OR，3.38[95%CI，1.55-7.35]；=0.002）、消瘦（OR，6.46[95%CI，2.81-14.8]；<0.001）和发育迟缓（OR，2.73[95%CI，1.40-5.34]；=0.003）是死亡的独立预测因素。对于感染和 ICU 停留时间也观察到类似的结果。消瘦是不良结局的最强预测因素。符合所有 3 项（消瘦、消瘦和消瘦）标准的患儿死亡的可能性比非营养不良患儿高 17.2 倍（<0.001）。
在接受 VSD 闭合手术的全球患儿队列中，营养不良与死亡率、感染和 ICU 停留时间延长有关。
