Evaluation Of Preoperative Nutritional Status And Effect On Clinical Outcome In Children With Congenital Heart Disease

Objective: To prospectively study on preoperative nutritional status and postoperative clinical outcome in children with congenital heart disease(CHD),so as to explore the changes of nutritional level perioperatively,give nutritional support purposely,improve the clinical outcome.Methods: 1 Case selection: 0~6 years old children with congenital heart disease who hospitalized in the Third Hospital of Xingtai and Xingtai People’s Hospital’s for surgical treatment between January,2013 and December,2016.2 Evaluation method: The nutritional status was evaluated with Z score according to age,height and weight.Evaluation indexes included HAZ(Height for Age),WAZ(Weight for Age)and WHZ(Weight for Height).WAZ<-2 was definited low weight,WHZ<-2 was definited symptosis,HAZ<-2 was definited growth retardation.Low weight or symptosis was judged acute malnutrition(AM),growth retardation was judged chronic malnutrition(CM).3 Observing indexes: 3.1 Indexes of body measurement: height,weight and head circumference(HC).3.2 Blood indexes: serum albumin(Alb),hemoglobin(Hb),total lymphocyte count(TLC)perioperativly.3.3 Indexes of clinical outcome: length of stay(LOS),cost of hospitalization and complication.Results: 130 cases were enrolled,51 boys,79 girls,age: 5month~6years old.(1)Evaluation of nutritional status by WAZ score:34 cases were low weight,accounted for 26.15%,96 cases were normal weight,accounted for 26.15%.Eexcept for preoperative weight,their age,height,HC,Alb,Hb and TLC were not significantly different(P>0.05);There were no differences in postoperative Alb,Hb,TLC,LOS,cost of hospitalization between two groups,but 1 decubital necrosis case and 2 pulmonary infection cases were occured in low weight group,the complication incidence in low weight group was significantly higher than that in normal weight group(P<0.05).(2)Evaluation of nutritional status by WHZ score:32 cases were symptosis,accounted for 24.62%,96 cases were normal,accounted for 75.38%.The preoperative age,height and weight in symptosis group were significantly lower than those in normal group(P<0.05),HC,Alb,Hb and TLC were also not significantly different between two groups(P>0.05);There were no differences in postoperative Alb,Hb,TLC,LOS,cost of hospitalization between two groups(P>0.05),but 1 decubital necrosis case and 2 pulmonary infection cases occured in low weight group,the complication incidence in symptosis group was significantly higher than that in normal group(P<0.05).(3)Evaluation of nutritional status by HAZ score:29 cases were growth retardation,accounted for 22.31%,101 cases were growth normal,accounted for 77.69%.The preoperative age,height,weight and HC in growth retardation group were significantly lower than those in growth normal group(P<0.05);Except for postoperative Alb,the Hb and TLC in growth retardation group were significantly lower than those in growth normal group(P<0.05).There were also no differences in postoperative LOS and cost of hospitalization between two groups(P>0.05),but 2 pulmonary infection cases occured in growth retardation group,1 decubital necrosis case occured in growth normal group,the complication incidences were significantly different between two groups(P<0.05).(4)Incidence of malnutrition distributed in different gender:32 cases of 130 CHD children existed acute malnutrition(AC),including 12 boys(incidence rate was 23.53%)and 20 girls(incidence rate was 25.32%).Incidence rate of AM was not significantly different between boys and girls(P>0.05).29 cases of 130 CHD children existed chronic malnutrition(CM),including 17 boys(incidence rate was 33.33%)and 12 girls(incidence rate was 15.19%).Incidence rate of CM in boys was significantly higher than that in girls(P<0.05).Conclusions:1 The preoperative nutritional status of 130 cases CHD children was evaluated by Z score,the results showed that CHD children existed different degree malnutrition,incidence rates of low weight,symptosis and growth retardation were 26.15%,24.62% and 22.31% respectively.2 CHD influenced physical development of children mainly,organ,muscle and immune function were not influenced significantly.3 There were no difference of postoperative Alb,Hb,TLC between AM children and normal children,the postoperative Alb,TLC of AM children were significantly lower than those of normal children.The incidence rate of complication of AM and CM children were significantly higher than that of normal children,but LOS and cost of hospitalization were similar.