Malnutrition in children with congenital heart defects

Objective: To assess the frequency of malnutrition in children with congenital heart defects in a hospital outpatient setting. Methods: One hundred and fifty-two children with congenital heart defects (patients), and an equal number of children with innocent cardiac murmurs (controls) attending the Pediatric Cardiology Outpatient Clinic at Sultan Qaboos University Hospital, Muscat, Oman from 1997 to 1998 were prospectively studied. Weight, height and head circumference were used for evaluation of nutritional status. Patients and controls were categorized into acute malnutrition (weight < 3rd percentile for age, and height > 3rd centile), and chronic malnutrition (weight and height < 3rd centile), based on the National Centre for Health Statistics standards. Children with symptomatic congenital heart defects (Group I, number = 73) were also compared with those without symptoms (Group II, number = 79). Results: The study patients showed a higher frequency of both acute (27%) and chronic (24%) malnutrition (p <0.01). Children in Group I had a significant reduction in weight (p <0.01), height (p=0.02) and head circumference (p <0.01) compared to controls, however for those in Group II the differences were not significant. Acute malnutrition was higher in both groups, 31% (p <0.01) and 16% (p=0.04), whilst chronic malnutrition was significantly higher only in Group I, 31% (p <0.01). Infants in Group I were more frequently affected (33/45) compared to older children (13/28; p=0.02). Conclusion: Malnutrition remains a problem among children with congenital heart defects, especially in those with either heart failure or cyanosis, and symptomatic infants are the worst affected. Greater attention is required in the dietary management, early diagnosis and intervention to restore normal growth.