Key result
A 1-unit decrease in preoperative weight-for-age z-score was associated with a significantly increased risk of 6-month mortality (OR 2.38) in infants undergoing congenital heart surgery.
Why the study?
Infants with congenital heart disease often experience feeding difficulties and malnutrition, prompting investigation into how preoperative anthropometry and biochemistry relate to postoperative outcomes.
Does low preoperative weight-for-age z-score predict increased 6-month mortality and postoperative complications in infants undergoing congenital heart surgery?
Cohort (n=167)
No
Does low preoperative weight-for-age z-score predict increased 6-month mortality and postoperative complications in infants undergoing congenital heart surgery?
Odds Ratio: 2.38 (95% CI 1.26–4.54)
p-value: p=0.008
Low preoperative weight-for-age z-score is a significant predictor of postoperative complications and 6-month mortality in infants undergoing congenital heart surgery.
Preoperative anthropometry may identify high-risk infants with CHD; hypothesis-generating and requires prospective validation before guiding care.
Aim: We explored the association between preoperative anthropometry and biochemistry, and postoperative outcomes in infants with CHD after cardiac surgery, as infants with congenital heart disease (CHD) often have feeding difficulties and malnutrition. Methodology This was a retrospective review of infants (≤ 1-year-old) who underwent congenital heart surgery. Preoperative anthropometryin terms of preoperative weight-for-age z-score (WAZ), length-for-age z-score (LAZ), as well as preoperative serum albumin and hemoglobin concentrations, were evaluated against 6-month mortality, and morbidity outcomes including postoperative complications, vasoactive inotrope score, duration of mechanical ventilation, length of stay in the pediatric intensive care unit and in hospital, using the logistic regression or median regression models accounting for infant-level clustering. Results One hundred and ninety-nine operations were performed in 167 infants. Mean gestational age at birth was 38.0 (SD 2.2) weeks (range 26 to 41 weeks). Thirty (18.0%) infants were born preterm (<37 weeks). The commonest acyanotic and cyanotic lesions were ventricular septal defect (26.3%, 44/167), and tetralogy of Fallot (13.8%, 23/167), respectively. Mean age at cardiac surgery was 94 (SD 95) days. Feeding difficulties, including increased work of breathing during feeding, diaphoresis, choking or coughing during feeding, and inability to complete feeds, was present in 54.3% (108/199) of infants prior to surgery, of which 21.6% (43/199) required tube feeding. The mean preoperative WAZ was−1.31 (SD 1.79). Logistic regression models showed that low preoperative WAZ was associated with increased risk of postoperative complications (odds ratio 1.82; p = 0.02), and 6-month mortality (odds ratio 2.38; p = 0.008) following CHD surgery. There was no meaningful association between the other preoperative variables and other outcomes. Conclusion More than 50% of infants with CHD undergoing cardiac surgery within the first year of life have feeding difficulties, of which 22% require to be tube-fed. Low preoperative WAZ is associated with increased postoperative complications and 6-month mortality.
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Lim et al. (2022) conducted a cohort in Congenital heart disease (n=167). 1-unit decrease in preoperative weight-for-age z-score (WAZ) vs. Baseline WAZ was evaluated on 6-month mortality (OR 2.38, 95% CI 1.26-4.54, p=0.008). A 1-unit decrease in preoperative weight-for-age z-score was associated with a significantly increased risk of 6-month mortality (OR 2.38) in infants undergoing congenital heart surgery.
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