Monique Radman1, Ricardo Mack2, Joaquin Barnoya3, Aldo Castañeda2, Monica Rosales2, Anthony Azakie4, Nilesh Mehta5, Roberta Keller6, Sanjeev Datar6, Peter Oishi1, Jeffrey Fineman7. 1. Pediatrics, University of California, San Francisco, Calif; Cardiovascular Research Institute, University of California, San Francisco, Calif. 2. Unidad de Cirugia Cardiovascular de Guatemala, Guatemala City, Guatemala. 3. Unidad de Cirugia Cardiovascular de Guatemala, Guatemala City, Guatemala; Surgery, Washington University, St. Louis, Mo; Division of Public Health Sciences, Washington University, St. Louis, Mo. 4. Surgery, University of California, San Francisco, Calif. 5. Pediatrics, Boston Children's Hospital, Boston, Mass. 6. Pediatrics, University of California, San Francisco, Calif. 7. Pediatrics, University of California, San Francisco, Calif; Cardiovascular Research Institute, University of California, San Francisco, Calif. Electronic address: jeff.fineman@ucsf.edu.
Abstract
OBJECTIVE: The objective of this study was to determine the association between preoperative nutritional status and postoperative outcomes in children undergoing surgery for congenital heart defects (CHD). METHODS: Seventy-one patients with CHD were enrolled in a prospective, 2-center cohort study. We adjusted for baseline risk differences using a standardized risk adjustment score for surgery for CHD. We assigned a World Health Organization z score for each subject's preoperative triceps skin-fold measurement, an assessment of total body fat mass. We obtained preoperative plasma concentrations of markers of nutritional status (prealbumin, albumin) and myocardial stress (B-type natriuretic peptide [BNP]). Associations between indices of preoperative nutritional status and clinical outcomes were sought. RESULTS: Subjects had a median (interquartile range [IQR]) age of 10.2 (33) months. In the University of California at San Francisco (UCSF) cohort, duration of mechanical ventilation (median, 19 hours; IQR, 29 hours), length of intensive care unit stay (median, 5 days; IQR 5 days), duration of any continuous inotropic infusion (median, 66 hours; IQR 72 hours), and preoperative BNP levels (median, 30 pg/mL; IQR, 75 pg/mL) were associated with a lower preoperative triceps skin-fold z score (P < .05). Longer duration of any continuous inotropic infusion and higher preoperative BNP levels were also associated with lower preoperative prealbumin (12.1 ± 0.5 mg/dL) and albumin (3.2 ± 0.1; P < .05) levels. CONCLUSIONS: Lower total body fat mass and acute and chronic malnourishment are associated with worse clinical outcomes in children undergoing surgery for CHD at UCSF, a resource-abundant institution. There is an inverse correlation between total body fat mass and BNP levels. Duration of inotropic support and BNP increase concomitantly as measures of nutritional status decrease, supporting the hypothesis that malnourishment is associated with decreased myocardial function.
OBJECTIVE: The objective of this study was to determine the association between preoperative nutritional status and postoperative outcomes in children undergoing surgery for congenital heart defects (CHD). METHODS: Seventy-one patients with CHD were enrolled in a prospective, 2-center cohort study. We adjusted for baseline risk differences using a standardized risk adjustment score for surgery for CHD. We assigned a World Health Organization z score for each subject's preoperative triceps skin-fold measurement, an assessment of total body fat mass. We obtained preoperative plasma concentrations of markers of nutritional status (prealbumin, albumin) and myocardial stress (B-type natriuretic peptide [BNP]). Associations between indices of preoperative nutritional status and clinical outcomes were sought. RESULTS: Subjects had a median (interquartile range [IQR]) age of 10.2 (33) months. In the University of California at San Francisco (UCSF) cohort, duration of mechanical ventilation (median, 19 hours; IQR, 29 hours), length of intensive care unit stay (median, 5 days; IQR 5 days), duration of any continuous inotropic infusion (median, 66 hours; IQR 72 hours), and preoperative BNP levels (median, 30 pg/mL; IQR, 75 pg/mL) were associated with a lower preoperative triceps skin-fold z score (P < .05). Longer duration of any continuous inotropic infusion and higher preoperative BNP levels were also associated with lower preoperative prealbumin (12.1 ± 0.5 mg/dL) and albumin (3.2 ± 0.1; P < .05) levels. CONCLUSIONS: Lower total body fat mass and acute and chronic malnourishment are associated with worse clinical outcomes in children undergoing surgery for CHD at UCSF, a resource-abundant institution. There is an inverse correlation between total body fat mass and BNP levels. Duration of inotropic support and BNP increase concomitantly as measures of nutritional status decrease, supporting the hypothesis that malnourishment is associated with decreased myocardial function.
Keywords:
18; 20; 21; B-type natriuretic peptide; BMI; BNP; CHD; CI; CPB; ICU; LOS; La Unidad de Cirugia Cardiovascular de Guatemala; PCICU; TSFZ; UCSF; UNICAR; University of California at San Francisco; WHO; World Health Organization; body mass index; cardiopulmonary bypass; confidence interval; congenital heart disease; intensive care unit; length of stay; pediatric cardiac intensive care unit; triceps skin-fold-for-age z score
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Maxime Cannesson; Clara Bionda; Bruno Gostoli; Olivier Raisky; Sylvie di Filippo; Dominique Bompard; Catherine Védrinne; Robert Rousson; Jean Ninet; Jean Neidecker; Jean-Jacques Lehot Journal: Anesth Analg Date: 2007-05 Impact factor: 5.108
Authors: Omar Chikovani; Jong-Hau Hsu; Roberta Keller; Tom R Karl; Anthony Azakie; Ian Adatia; Peter Oishi; Jeffrey R Fineman Journal: J Thorac Cardiovasc Surg Date: 2007-11 Impact factor: 5.209
Authors: Jong-Hau Hsu; Peter E Oishi; Roberta L Keller; Omar Chikovani; Tom R Karl; Anthony Azakie; Ian Adatia; Jeffrey R Fineman Journal: J Thorac Cardiovasc Surg Date: 2008-04 Impact factor: 5.209
Authors: Christy A N Okoromah; Ekanem N Ekure; Foluso E A Lesi; Wahab O Okunowo; Bolande O Tijani; Jonathan C Okeiyi Journal: Arch Dis Child Date: 2011-01-24 Impact factor: 3.791
Authors: Dongngan T Truong; Shaji C Menon; Linda M Lambert; Phillip T Burch; Xiaoming Sheng; L LuAnn Minich; Richard V Williams Journal: Pediatr Cardiol Date: 2018-05-24 Impact factor: 1.655
Authors: Michael L O'Byrne; Sunghee Kim; Christoph P Hornik; Babatunde A Yerokun; Roland A Matsouaka; Jeffrey P Jacobs; Marshall L Jacobs; Richard A Jonas Journal: Circulation Date: 2017-06-16 Impact factor: 29.690
Authors: Faith Ross; Gregory Latham; Denise Joffe; Michael Richards; Jeremy Geiduschek; Michael Eisses; Douglas Thompson; Monique Radman Journal: Cardiol Young Date: 2017-06-19 Impact factor: 1.093
Authors: Mitchell R Ladd; Alejandro V Garcia; Ira L Leeds; Courtney Haney; Maria M Oliva-Hemker; Samuel Alaish; Emily Boss; Daniel S Rhee Journal: J Pediatr Surg Date: 2018-04-27 Impact factor: 2.545
Authors: Jia Yi Joel Lim; Rui Wen Bryan Wee; Mihir Gandhi; Yee Phong Lim; Li Nien Michelle Tan; Swee Chye Quek; Marion M Aw; Ching Kit Chen Journal: Front Cardiovasc Med Date: 2022-04-01
Authors: Michael D Green; Devin M Parker; Allen D Everett; Luca Vricella; Marshall L Jacobs; Jeffrey P Jacobs; Jeremiah R Brown Journal: Ann Thorac Surg Date: 2020-08-25 Impact factor: 5.102