Konjenital kalp hastalarında ameliyat öncesi beslenme durumunun ameliyat sonrası mortalite ve morbidite ile ilişkisi

Abstract

Amaç: Bu çalışma konjenital kalp hastalığı nedeniyle ameliyat edilecek çocuk hastaların preoperatif beslenme durumu ile postoperatif morbidite ve mortalite arasındaki ilişkisini saptamak amacıyla planlanmıştır. Gereç ve Yöntemler: Çalışmaya konjenital kalp hastalığı nedeniyle ameliyat edilmek üzere hastaneye yatırılan 36 çocuk (3-60 ay) hasta dahil edilmiştir. Ameliyat öncesi hastaların beslenme durum değerlendirmesinde triseps deri kıvrım kalınlığı (TDKK) ölçümleri kullanılmıştır. Operasyon sonrası hastaların yoğun bakımda kalış süreleri, mekanik ventilatörde kalış süreleri, inotrop gereksinimleri ve süreleri ile 30 günlük mortalite kaydedilmiştir. Bulgular: Preoperatif dönemde hastaların %8.3’ünün TDKK Z-skor değerleri <-1 SD altında; %66.7’sinin ise -1 ile +1 SD arasında saptanmıştır. Preoperatif dönemde ölçülen triseps deri kıvrım kalınlığı ile ekstübasyon süresi (p=0.523), yoğun bakım kalış süresi (p=0.551), inotrop alma süresi (p=0.889) ve 30 günlük mortalite (p>0.05) arasında istatistiksel açıdan anlamlı fark bulunmamıştır. Sonuçlar: Konjenital kalp hastalığı olan çocuk hastalarda preoperatif beslenme durum ile postoperatif morbidite ve mortalite arasında anlamlı bir ilişki saptanmamıştır.

Keywords

• Triseps deri kıvrım kalınlığı
• Beslenme durumu
• Konjenital kalp hastalığı

The relationship between preoperative nutritional status with postoperative mortality and morbidity in congenital heart patients

Abstract

Aim: This study aimed to determine the relationship between preoperative nutritional status and postoperative mortality and morbidity in pediatric patients undergoing congenital heart surgery. Material and Methods: The study enrolled 36 pediatric patients, aged between 3 and 60 months, who were hospitalized for congenital heart surgery. Nutritional status assessment involved measuring the triceps skinfold thickness (TSFT) prior to surgery. The investigation focused on establishing associations between the provided preoperative data and various postoperative outcomes, including duration of Intensive Care Unit (ICU) stay, mechanical ventilator requirements, inotrope usage, and 30-day mortality.” Results: In the preoperative period, 8.3% of the patients were below <-1 SD; 66.7% of them were found to be between -1 and +1 SD according to TSFT Z-score charts. There was no statistically significant correlation between preoperative triceps skinfold thickness Z score and extubation time (p=0.523), intensive care unit stay (p=0.551), inotrope intake duration (p=0.889) and 30-day mortality (p>0.05). Conclusion: No significant correlation was found between preoperative nutritional status and postoperative morbidity and mortality in pediatric patients.

Keywords

• Triceps skinfold thickness
• Nutritional status
• Congenital heart disease

References

1. Singh N, Gupta D, Aggarwal AN, Agarwal R, Jindal SK. An assessment of nutritional support to critically ill patients and its correlation with outcomes in a respiratory intensive care unit. Respir Care. 2009;54:1688-96.
2. Leite H, de Camargo CA, Fisberg M. Nutritional status of children with congenital heart disease and left-to-right shunt. The importance of the presence of pulmonary hypertension. Arq Bras Cardiol. 1995;65:403-7.
3. Toole BJ, Toole LE, Kyle UG, Cabrera AG, Orellana RA, Coss‐Bu JA. Perioperative nutritional support and malnutrition in infants and children with congenital heart disease. Congenit Heart Dis. 2014;9:15-25.
4. Hulst J, Joosten K, Zimmermann L, et al. Malnutrition in critically ill children: from admission to 6 months after discharge. Clin Nutr. 2004;23:223-32.
5. Radman M, Mack R, Barnoya J, et al. The effect of preoperative nutritional status on postoperative outcomes in children undergoing surgery for congenital heart defects in San Francisco (UCSF) and Guatemala City (UNICAR). J Thorac Cardiovasc Surg. 2014;147:442-50.
6. Cameron JW, Rosenthal A, Olson AD. Malnutrition in hospitalized children with congenital heart disease. Arch Pediatr Adolesc Med. 1995;149:1098-102.
7. Udani S. Feeding in the PICU. Indian J Pediatr. 2001;68:333-7.
8. Varan B, Tokel K, Yilmaz G. Malnutrition and growth failure in cyanotic and acyanotic congenital heart disease with and without pulmonary hypertension. Arch Dis Child. 1999;81:49-52.

9. Mehta NM, Duggan CP. Nutritional deficiencies during critical illness. Pediatr Clin North Am. 2009;56:1143-60.
10. Dündar N, Dündar B, Öktem F. Doğumsal kalp hastalıkları ve büyüme geriliği. SDÜ Tıp Fakültesi Dergisi. 2007;14.
11. Al-Radi OO, Harrell Jr FE, Caldarone CA, et al. Case complexity scores in congenital heart surgery: a comparative study of the Aristotle Basic Complexity score and the Risk Adjustment in Congenital Heart Surgery (RACHS-1) system. J Thorac Cardiovasc Surg. 2007;133:865-75.
12. World Health Organization. Child growth standarts, Triceps skin fold-for-age. . Access date: 17.2.2024.
13. Mehrizi A, Drash A. Growth disturbance in congenital heart disease. J Pediatr. 1962;61:418-29.
14. Nydegger A, Bines JE. Energy metabolism in infants with congenital heart disease. Nutrition. 2006;22:697-704.
15. Menon G, Poskitt E. Why does congenital heart disease cause failure to thrive? Arch Dis Child. 1985;60:1134-9.
16. Webb JG, Kiess MC, Chan-Yan CC. Malnutrition and the heart. CMAJ: Can Med Assoc J. 1986;135:753.
17. Cavell B. Gastric emptying in preterm infants. Acta Paediatr. 1979;68:725-30.
18. Ng A, Smith G. Gastroesophageal reflux and aspiration of gastric contents in anesthetic practice. Anesth Analg 2001;93:494-513.
19. Lim CYS, Lim JKB, Moorakonda RB, et al. The impact of pre-operative nutritional status on outcomes following congenital heart surgery. Front Pediatr. 2019;7:429.
20. Lim JYJ, Wee RWB, Gandhi M, et al. The Associations Between Preoperative Anthropometry and Postoperative Outcomes in Infants Undergoing Congenital Heart Surgery. Front Cardiovasc Med. 2022;9:812680.
21. Mitting R, Marino L, Macrae D, Shastri N, Meyer R, Pathan N. Nutritional status and clinical outcome in postterm neonates undergoing surgery for congenital heart disease. Pediatr Crit Care Med. 2015;16:448-52.
22. Polat S, Okuyaz C, Hallıoğlu O, Mert E, Makharoblidze K. Evaluation of growth and neurodevelopment in children with congenital heart disease. Pediatr Int. 2011;53:345-9.
23. Ahmad M, Ahmed H, Airede K. Triceps skin fold thickness as a measure of body fat in Nigerian adolescents. Niger J Paediatr. 2013;40(2):179-83.
24. Himes JH, Roche AF, Webb P. Fat areas as estimates of total body fat. Am J Clin Nutr. 1980;33:2093-100.
25. Hsu J-H, Keller RL, Chikovani O, Cheng H, Hollander SA, Karl TR, et al. B-type natriuretic peptide levels predict outcome after neonatal cardiac surgery. J Thorac Cardiovasc Surg. 2007;134:939-45.
26. Kelleher DK, Laussen P, Teixeira-Pinto A, Duggan C. Growth and correlates of nutritional status among infants with hypoplastic left heart syndrome (HLHS) after stage 1 Norwood procedure. Nutrition. 2006;22:237-44.