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8/13/2019 Jurnal Belle

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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) normalin 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 theones most severely affected



Background of the Study

WHO defines malnutrition as the cellular

imbalance between the supply of nutrients

and energy and the body’s 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 (skinlesions, 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 lengthor 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

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