The Associations Between Preoperative Anthropometry and Postoperative Outcomes in Infants Undergoing Congenital Heart Surgery

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

doi:10.3389/fcvm.2022.812680

The Associations Between Preoperative Anthropometry and Postoperative Outcomes in Infants Undergoing Congenital Heart Surgery

Front Cardiovasc Med. 2022 Apr 1:9:812680. doi: 10.3389/fcvm.2022.812680. eCollection 2022.

Authors

Jia Yi Joel Lim¹, Rui Wen Bryan Wee¹, Mihir Gandhi^{2

3

4}, Yee Phong Lim⁵, Li Nien Michelle Tan⁶, Swee Chye Quek^{5

7}, Marion M Aw^{5

6}, Ching Kit Chen^{5

7}

Affiliations

¹ Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
² Biostatistics, Singapore Clinical Research Institute, Consortium for Clinical Research and Innovation Singapore, Singapore, Singapore.
³ Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore.
⁴ Tampere Center for Child Health Research, Tampere University, Tampere, Finland.
⁵ Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
⁶ Division of Gastroenterology, Nutrition, Hepatology and Liver Transplantation, Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore.
⁷ Division of Cardiology, Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore.

Abstract

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.

Keywords: 6-month mortality; cardiac surgery; congenital heart disease; feeding difficulties; infants; nutritional status; postoperative complications; preoperative weight-for age z-score.