medigraphic.com
Boletín Médico del Hospital Infantil de México

2010, Número 5

<< Anterior Siguiente >>

Bol Med Hosp Infant Mex 2010; 67 (5)


Impact of nutritional support on length of hospitalization and mortality in children after open heart surgery

Vivanco-Muñoz N, Buendía-Hernández A, Talavera PJO, Juanico-Enríquez A, Clark PP

Idioma: Ingles.
Referencias bibliográficas: 43
Paginas: 430-438
Archivo PDF: 270.87 Kb.


RESUMEN

Background. Malnutrition is a common cause of morbidity in children with congenital heart disease (CHD). The aim of this study was to assess the impact of malnutrition and nutritional support on the length of hospitalization and mortality at the Pediatric Intensive Care Unit (PICU) in children with CHD after undergoing surgery.
Methods. Clinical records (2000-2008) of patients ≤3 years old with CHD who were admitted for surgery were evaluated for nutritional status, nutritional support, and risk factors. Mortality was evaluated from the beginning of surgery and during the patient’s stay at the PICU. Long-term hospitalization was considered according to the length of hospital stay on percentile ›50. A multiple logistic regression model was used.
Results. Two hundred eighty nine patients were included. Factors related to mortality were malnutrition before surgery (OR 3.447; 95% CI 1.006–11.812, p = 0.049), early or delayed enteral nutrition (OR 0.007; 95% CI 0.000–0.097, p = 0.000, and OR 0.011; 95% CI 0.001–0.126, p = 0.000, respectively), and early parenteral nutrition (OR 0.032; 95% CI 0.002–0.452, p = 0.000) vs. no nutritional support. Factors related to long-term stay were malnutrition at birth (OR 2.772; 95% CI 1.282–5.995, p = 0.010) and delayed parenteral nutrition (OR 12.049; 95% CI 1.626–94.724, p = 0.015).
Conclusion. Malnutrition at birth and before surgery increases length of stay and mortality of children after open heart surgery. Early nutritional support reduces length of stay and mortality.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Clark EB. Etiology of congenital cardiovascular malformations: epidemiology and genetics. In: Allen HD, Clark EB, Gutgesell HP, Driscoll DJ, eds. Moss and Adams’ Heart Disease in Infants, Children and Adolescents, Including the Fetus and Young Adult. Philadelphia: Lippincott Williams & Wilkins, 2001. pp. 65-79.

  2. Rosenthal GR. Incidence and prevalence of congenital heart disease. In: Garson A, Bricker JT, Fisher DJ, Neish SR, eds. The Science and Practice of Pediatric Cardiology. Baltimore: Williams & Wilkins, 1998. pp. 1083-1085.

  3. Azevedo VM, Albanesi-Filho FM, Santos MA, Castier MB, Tura BR. The impact of malnutrition on idiopathic dilated cardiomyopathy in children. J Pediatr (Rio J) 2004;80:206-211.

  4. Martins da Silva V, de Oliveira Lopes MV, Leite de Araujo T. Evaluation of the growth percentiles of children with congenital heart disease. Rev Lat Am Enfermagem 2007;15:298-303.

  5. Mitchell IM, Logan RW, Pollock JC, Jamieson MP. Nutritional status of children with congenital heart disease. Br Heart J 1995;73:277-283.

  6. Peterson RE, Wetzel GT. Growth failure in congenital heart disease: where are we now? Curr Opin Cardiol 2004;19:81-83.

  7. Salzer HR, Haschke F, Wimmer M, Heil M, Schilling R. Growth and nutritional intake of infants with congenital heart disease. Pediatr Cardiol 1989;10:17-23.

  8. Thompson COC, Reyes TN, Rabiela BOL, Buendía HA, Miranda CI, Carrasco QR. The nutritional status of the child with congenital cardiopathy. Arch Inst Cardiol Mex 1998;68:119-123.

  9. Varan B, Tokel K, Yilmaz G. Malnutrition and growth failure in cyanotic and acyanotic congenital heart disease with and without pulmonary hypertension. Arch Dis Child 1999;81:49-52.

  10. Villasís-Keever MA, Aquiles Pineda-Cruz R, Halley-Castillo E, Alva-Espinosa C. Frequency and risk factors associated with malnutrition in children with congenital cardiopathy. Salud Publica Mex 2001;43:313-323.

  11. Mustafa I, Leverve XM. Metabolic and nutritional disorders in cardiac cachexia. Nutrition 2001;17:756-760.

  12. Nichols DG, Ungerleisder RM, Spevak PJ, Greeley WJ, Cameron DE, Lappe DG, et al. Perioperative monitoring. In: Nichols DG, Cameron DE, eds. Critical Heart Disease in Infants and Children. Baltimore: Elsevier Health Sciences, 2006. pp. 479-506.

  13. Engelman DT, Adams DH, Byrne JG, Aranki SF, Collins JJ Jr, Couper GS, et al. Impact of body mass index and albumin on morbidity and mortality after cardiac surgery. J Thorac Cardiovasc Surg 1999;118:866-873.

  14. Giner M, Laviano A, Meguid MM, Gleason JR. In 1995 a correlation between malnutrition and poor outcome in critically ill patients still exists. Nutrition 1996;12:23-29.

  15. Kulier A, Levin J, Moser R, Rumpold-Seitlinger G, Tudor IC, Snyder-Ramos SA, Moehnle P, Mangano DT; Investigators of the Multicenter Study of Perioperative Ischemia Research Group; Ischemia Research and Education Foundation. Impact of preoperative anemia on outcome in patients undergoing coronary artery bypass graft surgery. Circulation 2007;116:471-479.

  16. Potapov EV, Loebe M, Anker S, Stein J, Bondy S, Nasseri BA, et al. Impact of body mass index on outcome in patients after coronary artery bypass grafting with and without valve surgery. Eur Heart J 2003;24:1933-1941.

  17. Ray DE, Matchett SC, Baker K, Wasser T, Young MJ. The effect of body mass index on patient outcomes in a medical ICU. Chest 2005;127:2125-2131.

  18. Davis S, Cox AC, Piedmonte M, Drummond-Webb JJ, Mee RB, Harrison AM. Prolonged mechanical ventilation after cardiac surgery in young children: incidence, etiology and risk factors. J Intensive Care Med 2002;17:302-307.

  19. Yap CH, Mohajeri M, Yii M. Obesity and early complications after cardiac surgery. Med J Aust 2007;186:350-354.

  20. Lechner E, Weisinger-Eidenberger G, Weissensteiner M, Hofer A, Tulzer G, Sames-Dolzer E, et al. Open-heart surgery in premature and low-birth-weight infants--a single-centre experience. Eur J Cardiothorac Surg 2009;36:986-991.

  21. Dorfman AT, Marino BS, Wernovsky G, Tabbutt S, Ravishankar C, Godinez RI, et al. Critical heart disease in the neonate: presentation and outcome at a tertiary care center. Pediatr Crit Care Med 2008;9:193-202.

  22. Pedersen KR, Hjortdal VE, Christensen S, Pedersen J, Hjortholm K, Larsen SH, et al. Clinical outcome in children with acute renal failure treated with peritoneal dialysis after surgery for congenital heart disease. Kidney Int Suppl 2008:S81-S86.

  23. Pierro A, Eaton S. Metabolism and nutrition in the surgical neonate. Semin Pediatr Surg 2008;17:276-284.

  24. Duggan C, Walker WA, Hendricks KM. The critically ill patients. In: Walker WA, ed. Manual of Pediatric Nutrition. Hamilton, Ontario: Decker; 2005.

  25. Attie F, Buendía-Hernández A, Zabal C. Introducción. In: Attie F, Buendía-Hernández A, Zabal C, eds. Cardiología Pediátrica, Diagnóstico y Tratamiento. México: Médica Panamericana, 1994. pp. 26-31.

  26. Centers for Disease Control (CDC). Pediatric Reference Growth Charts, 2000. Available at: http://www.cdc.gov/growthcharts/2000

  27. WHO. Child Growth Standards, 2007. Available at: http://www.who.int/childgrowth/standards/second_set/technical_report_2.pdf

  28. Seal A, Kerac M. Operational implications of using 2006 World Health Organization growth standards in nutrition programmes: secondary data analysis. BMJ 2007;334:733.

  29. Zeferino AM, Barros Filho AA, Bettiol H, Barbieri MA. Monitoring growth. J Pediatr (Rio J) 2003;79(suppl 1):S23-S32.

  30. Eto C, Komiya S, Nakao T, Kikkawa K. Validity of the body mass index and fat mass index as an indicator of obesity in children aged 3-5 year. J Physiol Anthropol Appl Human Sci 2004;23:25-30.

  31. Mackie AS, Gauvreau K, Newburger JW, Mayer JE, Erickson LC. Risk factors for readmission after neonatal cardiac surgery. Ann Thorac Surg 2004;78:1972-1978.

  32. Colpan A, Akinci E, Erbay A, Balaban N, Bodur H. Evaluation of risk factors for mortality in intensive care units: a prospective study from a referral hospital in Turkey. Am J Infect Control 2005;33:42-47.

  33. Marcin JP, Slonim AD, Pollack MM, Ruttimann UE. Long-stay patients in the pediatric intensive care unit. Crit Care Med 2001;29:652-657.

  34. Chen YC, Lin SF, Liu CJ, Jiang DD, Yang PC, Chang SC. Risk factors for ICU mortality in critically ill patients. J Formos Med Assoc 2001;100:656-661.

  35. Gilio AE, Stape A, Pereira CR, Cardoso MF, Silva CV, Troster EJ. Risk factors for nosocomial infections in a critically ill pediatric population: a 25-month prospective cohort study. Infect Control Hosp Epidemiol 2000;21:340-342.

  36. Cağatay AA, Ozcan PE, Gulec L, Ince N, Tugrul S, Ozsut H, et al. Risk factors for mortality of nosocomial bacteraemia in intensive care units. Med Princ Pract 2007;16:187-192.

  37. Heyland DK, McDonald S, Keefe L, Drover JW. Total parenteral nutrition in the critically ill patient: a meta-analysis. JAMA 1998;280:2013-2019.

  38. Gramlich L, Kichian K, Pinilla J, Rodych NJ, Dhaliwal R, Heyland DK. Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition 2004;20:843-848.

  39. Simpson F, Doig GS. Parenteral vs. enteral nutrition in the critically ill patient: a meta-analysis of trials using the intention to treat principle. Intensive Care Med 2005;31:12-23.

  40. García Vila B, Grau T. Early enteral nutrition in the critically-ill patient. Nutr Hosp 2005;20:93-100.

  41. Mesejo A, Juan M, García-Simón M. Enteral access and intestinal function assessment in the critically ill patient. Nutr Hosp 2007;22(suppl 2):37-49.

  42. Radrizzani D, Bertolini G, Facchini R, Simini B, Bruzzone P, Zanforlin G, et al. Early enteral immunonutrition vs parenteral nutrition in critically ill patients without severe sepsis: a randomized clinical trial. Intensive Care Med 2006;32:1191-1198.

  43. Sena MJ, Utter GH, Cuschieri J, Maier RV, Tompkins RG, Harbrecht BG, et al. Early supplemental parenteral nutrition is associated with increased infectious complications in critically ill trauma patients. J Am Coll Surg 2008;207:459-467.




2020     |     www.medigraphic.com