JOURNAL Malnutrition and growth failure in cyanotic and acyanotic congenital heart disease with and without pulmonary

hypertension

Perceptor : dr. Manan Affandi, Sp.A dr. Rachmat Gumelar, Sp.A dr. Tina Ramayanthi, Sp.A

Bellinda Nadya Putri 1102007059

Abstract
Aim : To investigate the effect of several types of congenital heart disease (CHD) on nutrition and growth Patients : Malnutrition and growth failure was investigated in 89 patients with CHD aged 1-45 months and they were according to cardiac diagnosis : cyanotic with pulmonal hypertension (cP), cyanotic without pulmonal hypertension (cp), acyanotic with pulmonal hypertension (aP) and acyanotic without pulmonal hypertension (ap) Methods : - Using standard measurements of weight, length and head circumference, for physical signs of malnutrition (skin lesions, thin and weak hair) were made by one nurse - Interview with patients parents

Results :There was no significant difference between groups in term of parental education status, sosioeconomic level, duration of breast feeding, and number of siblings Group cP (cyanotic patients with pulmonary hypertension) including to moderate to severe malnutrition Group aP (acyanotic patients with pulmonary hypertension) including to mild or borderline malnutrition Group cp (cyanotic patients without pulmonary hypertension) normal in nutritional state
Conclusions: Patients with CHD are prone to malnutrition and growth failure. Pulmonary hypertension appears to be the most important factor, and cyanotic patients with pulmonary hypertension are the ones most severely affected

Background of the Study

WHO defines malnutrition as the cellular imbalance between the supply of nutrients and energy and the bodys demand for them to ensure growth, maintenance, and specific functions

Patients & Methods

89 patients with cardiac diagnosis Patients were assigned to four groups (aP, ap, cP, and cp) Information on sosioeconomic level, education status of the parents, patients birth weight, nutrition hystory by interview with patients parents Standardised measurements by one nurse for physical examination, checking their weight, length, head circumference, and physical signs of malnutrition (skin lesions, thin and weak hair) Measurements of pulmonary artery pressure, pulmonary vasculary resistence index, aortic oxygen saturation, haemoglobin, albumin and venous pH

Results
Low family sosioeconomic level may have contributed in the causing of this disease Cyanotic patients without pulmonary hypertension were normal weight for their length or were mildly malnourished (88%), 48% were stunted, and 40% failure to thrive Cyanotic patients with pulmonary hypertension were the most severely affected, 81% having malnutrition, 56% having moderate to severe malnutrition, 56% failure to thrive

Discussion

What is the importance of nutrition support in patients with congenital heart disease ?

Incidence of Malnutrition in CHD

Patients with CHD there is an in the frequency and severity of acute / chronic malnutrition Failure to thrive in infants with CHD Aggressive nutrition intervention is vital to prevent unsuccessful outcomes associated with malnutrition

Etiology of Malnutrition
Inadequate caloric intake Increased energy expenditure due to increased respiratory rate and/or increase metabolic rate Effects of hypoxia on cellular metabolism

Energy Expenditure
Decreased rates of weight gain in group with CHD 49% of study population with inadequate intake due to fatigue and tachypnea Cyanotic patients with pulmonary hypertension severely affected with malnutrition

Conclusion
In this study shows the additive effects of hypoxia and pulmonary hypertension on nutrition and growth of children with CHD