Does malnutrition influence outcome in children undergoing congenital heart surgery in a developing country?

  • Eva M. Marwali Division of Pediatric Cardiac ICU, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
  • Sekarpramita Darmaputri Division of Pediatric Cardiac ICU, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
  • Dadang H. Somasetia Department of Child Health, Universitas Padjadjaran Medical School/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
  • Sudigdo Sastroasmoro Center for Clinical Epidemiology and Evidence-based Medicine, Medical School University of Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Nikolaus A. Haas Department of Congenital Heart Defect, Heart and Diabetes Center Northrhein Westfalia, Bad Oeynhausen, Germany
  • Michael A. Portman Division of Cardiology, Seattle Children’s Hospital and Research Institute, University of Washington, Seattle, USA
Keywords: malnutrition, congenital heart disease, cardiopulmonary bypass, intubation time


Background Most children undergoing cardiac surgery for
congenital heart disease (CHD) in developing countries are
malnourished. Malnutrition is known as a co-morbidity factor
that might predict and influence outcomes after surgery.
Objectives To evaluate the effect of malnutrition and other
associated risk factors on post-operative outcomes in children
with CHDs underwent cardiac surgery.
Methods We conducted a retrospective cohort study in a single
center tertiary pediatric cardiac intensive care unit (PCICU)
in Indonesia. Our cohort included all children between 5 and
36 months of age undergoing congenital heart surgery with
cardiopulmonary bypass from November 2011 until February
2014. Outcomes measured were the length of intubation and the
length of ICU stay. Variables for potential influence investigated
were the nutritional status, age, gender, type of cardiac anomaly
(acyanotic vs. cyanotic), Aristotle score, cardiopulmonary bypass
time, aortic cross-clamp time, and Pediatric Risk of Mortality
(PRISM) III score.
Results Out of 249 patients included, 147 (59%) showed
malnourishment on admission. Malnourished patients were
significantly younger in age, presented with an acyanotic heart
defects, and had higher PRISM III score. Additionally, they also
had a longer mechanical ventilation time and ICU stay than
those with a normal nutritional status. After adjusting for various
variables using a multiple logistic regression model it could be
demonstrated that a higher Z-score for weight to age was a
significant protective factor for the intubation time of more than
29 hours with an odds ratio of 0.66 (95% CI 0.48 to 0.92, P =
0.012). Non-malnourished patients had a 49% significantly higher
chance for extubation with a hazard ratio of 1.49 (95% CI 1.12
to 1.99, P= 0.007).

Conclusion Malnourishment is clearly associated in a linear
fashion with longer mechanical ventilation and ICU stay. As one of
significant and potentially treatable co-morbidity factors, prevention
of malnourishment by early diagnosis and optimal timing for surgery
is important.


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How to Cite
Marwali EM, Darmaputri S, Somasetia DH, Sastroasmoro S, Haas NA, Portman MA. Does malnutrition influence outcome in children undergoing congenital heart surgery in a developing country?. PI [Internet]. 30Apr.2015 [cited 15Jul.2024];55(2):109-6. Available from:
Received 2016-06-29
Accepted 2016-06-29
Published 2015-04-30