(762) Preoperative Nutrition and Postoperative Outcomes in CHD Children: Systematic Review & Meta-Analysis

Introduction: Congenital heart disease (CHD) is the most common birth defect. Despite advancements in CHD surgery, mortality is substantial, especially in low-middle income countries. Evidence shows malnutrition contributes to morbidity and mortality in CHD patients, with negative impacts on their surgical outcomes. Postoperative feeding contributes to fewer complications in children undergoing CHD surgery. However, systematic reviews previously have only focused on nutritional status in children with CHD without assessing postoperative outcomes related to malnutrition. This review aims to systematically study the impact of pre-operative nutritional status on immediate post-operative outcomes in CHD patients.

Methods: PubMed, MEDLINE, CINAHL, Embase, and the Cochrane Library were used for the literature search. Quantitative studies published after the year 2000, assessing the impact of preoperative nutritional status on postoperative outcomes of children ≤18 years undergoing CHD surgery were eligible for the review. Data was extracted by two independent researchers using a standardized template created in Covidence™. Postoperative outcomes, including hospital and Intensive Care Unit (ICU) length of stay (LOS), mechanical ventilation time (MV), postoperative infection, and mortality rates, were compared between well-nourished and malnourished patients using WHO classification.

Results: 11 studies were included in this review with a total of 1903 malnourished and 4555 well-nourished children with CHD. Majority of these were from upper-middle- and high-income countries. Malnourished children had a significantly longer LOS in the hospital (Standard Mean Difference/SMD: -0.37 [-0.59, -0.16] P= 0.0005) and ICU (SMD: -0.53 [-0.68, -0.37] P< 0.00001), and higher risk of prolonged MV (SMD: -0.45 [-0.64, -0.26] P< 0.00001). There was no significant difference in mortality (OR 0.59 [0.33, 1.04] P= 0.07) and postoperative infection rates (OR 0.92 [0.35, 2.47] P= 0.87) between the two groups.

Conclusions: Malnourished children have a longer hospital and ICU stay, and prolonged MV after CHD surgery compared to well-nourished children. Further research is needed to identify effective nutritional interventions to improve outcomes in children with CHD, and to develop and evaluate new malnutrition assessment methods in them.