ASSOCIATION BETWEEN WEIGHT FOR AGE AND CLINICAL OUTCOMES IN CHILDREN UNDERGONE CARDIAC SURGER
Objective: To find out the frequency of underweight children with CHD and find out the association between weight for age and clinical outcomes in children undergone cardiac surgery.
Study Design: Descriptive cross sectional study.
Place and Duration of Study: Armed Forces Institute of Cardiology & National Institute of Heart Diseases Rawalpindi, from Jan 2018 to Aug 2019.
Methodology: Retrospective analysis was performed on all patients of age one month to five years undergoing cardiac surgery. A total of 575 patients satisfied the inclusion criteria for the study. Data regarding age, gender, ethnicity, height, disease, procedure, RACHS score, co morbidity was collected. Mortality was marked as the primary outcome. Secondary outcomes included length of stay, clamp time, duration of ventilation, bypass time in intensive care, ionotropic support, infection, reventilation, neurological complication, renal complication, fever, reopening, and pulmonary edema. The data was analyzed using the statistical package for social sciences version 23.
Results: Mean weight for age 14.7 percentile ± 26.8 and mean z score was 2.3 ± 2.98 whereas mean age was 27 months ± 17.8, mean weight was 10 ± 3.68. Mortality in normal weight babies (Z<−2) was 3.4%, but increased to 47% in underweight, and 49% in severely underweight patients. Significant association was seen between total ventilation time, X-Clamp time in minutes, total hospital stay in days and CPB time in minutes with weight for age Z score (WAZ score).
Conclusion: This study exhibits the effect of underweight, indicated by weight for age z score, on mortality and adverse outcomes after pediatric cardiac surgery in a wide range of patient ages. There is no data on specific nutritional interventions that will improve weight in this high-risk population but addition of a dietitian to the medical team for infants with congenital heart disease has been shown to improve weight in the first few months of life.