Undernutrition in young children with congenital heart disease undergoing cardiac surgery in a low-income environment

Prevalence of undernutrition and associated factors among children with congenital heart disease in Africa: a systemic review and meta-analysis

BACKGROUND

Undernutrition is a major public health issue in children with congenital heart disease in Africa. In this continent, the degree of undernutrition also varies from country to country. Therefore, summarizing data concerning undernutrition in children with congenital heart disease is essential to refine treatment guidelines and policies. This meta-analysis aims to deliver pooled data concerning undernutrition among African children with congenital heart disease.

METHODS

In this review, relevant studies were searched via PubMed/MEDLINE online, Science Direct, Hinari, Web of Science, CINHAL, EMBASE, WHO database, Google, and Google Scholar. To conduct this review, PRISMA guidelines were used. STATA 17 was used to estimate the pooled prevalence of undernutrition in children. A random effect meta-analysis model was used to conduct this meta-analysis. The heterogeneity of the studies was evaluated by the I2 test. Publication bias was assessed via funnel plots supplemented with Egger's weighted regression test. Finally, for all analyses, p < 0.05 was considered statistically significant.

RESULT

In this review, a total of 5898 studies were found. Among these, 5878 were excluded using PRISMA, and the remaining 20 studies were included in the final analysis. The prevalence of undernutrition, underweight, wasting, and stunting in children with congenital heart disease was 65.14% (95% CI 51.32-78.95, I2 = 97.4%, p = 0.0001), 45.76% (95% CI 35.83-55.69, I2 = 96.7, p < 0.0001), 39.37% (95% CI 29.55-49.19, I2 = 97.4, p < 0.0001), and 39.38% (95% CI 33.02-45.72, I2 = 92.4%, p < 0.0001), respectively. Anemia (OR = 4.5, 95% CI 1.60-12.68), CHF (OR = 5.98, 95% CI 3.09-11.57), pulmonary hypertension (OR = 2.76, 95% CI 1.89-4.04), and age (OR = 2.78, 95% CI 1.79-4.31) were associated with undernutrition in children with CHD.

CONCLUSION

In this meta-analysis, the pooled prevalence of undernutrition and its indicators in children with CHD were high. As a result, there is still a need to improve early screening and treatment of undernutrition in children with congenital heart disease concomitant with early screening and treatment of congenital heart disease and its common complications in Africa.

Surgical and postoperative management of congenital heart disease: a systematic review of observational studies

BACKGROUND

Congenital heart disease (CHD) remains a critical concern in pediatric and adult cardiovascular care, requiring continuous advancements in surgical techniques and perioperative strategies. While survival rates have improved, challenges persist in optimizing long-term neurodevelopmental outcomes, addressing disparities in healthcare access, and overcoming systemic barriers to implementing best practices. This systematic review integrates recent evidence on predictive factors, perioperative innovations, and economic challenges affecting CHD management.

METHODS

A systematic review was conducted, analyzing data from 27 observational studies, including retrospective and prospective cohort studies, as well as case reports, sourced from diverse geographic and clinical settings. Studies were selected based on strict inclusion criteria, emphasizing clear surgical outcomes, perioperative advancements, and neurodevelopmental follow-up. Data were extracted and synthesized to identify key trends in CHD surgery, anesthetic management, and long-term patient care.

RESULTS

Key findings include: • Neurodevelopmental Outcomes: Long-term follow-up studies identified associations between prolonged ICU stays, intraoperative cerebral oxygenation deficits, and developmental delays. Hearing loss was reported in 21.6% of post-surgical patients, significantly impacting cognitive and language abilities. • Predictive Factors for Postoperative Outcomes: Hemoglobin saturation, lactate levels, and platelet counts were statistically associated with adverse postoperative outcomes (p < 0.05), reinforcing the need for preoperative risk stratification. • Fast-Track Extubation and Resource Optimization: Early extubation protocols reduced ICU stays by an average of 20%, with a 15% decrease in postoperative complications. However, financial disincentives and inadequate reimbursement models limited their widespread adoption, particularly in low-resource settings. • Tailored Anesthetic Techniques: Individualized anesthesia strategies, including neuroprotective approaches and blood conservation techniques, improved outcomes in high-risk CHD populations, reducing complication rates by up to 10%. • Global Disparities in CHD Care: Studies from low-income countries revealed significantly higher rates of malnutrition, delayed surgical interventions, and postoperative complications. These disparities highlight the urgent need for global policy reforms to improve healthcare equity in CHD management.

CONCLUSION

This review highlights the necessity of integrating predictive analytics, multidisciplinary approaches, and healthcare system reforms to enhance CHD management. While advancements in surgical techniques and perioperative care yield promising outcomes, persistent challenges-including healthcare disparities, financial constraints, and long-term neurodevelopmental risks-require targeted interventions. Future research should focus on personalized care models, global health policy adjustments, and innovative technologies to optimize CHD patient outcomes.

Home-ics: how experiences of the home impact biology and child neurodevelopmental outcomes

Studies on the -omics of child neurodevelopmental outcomes, e.g. genome, epigenome, microbiome, metabolome, and brain connectome aim to enable data-driven precision health to improve these outcomes, or deliver the right intervention, to the right child, at the right time. However, evidence suggests that neurodevelopmental outcomes are shaped by modifiable socioenvironmental factors. Everyday exposures including family and neighbourhood-level socioeconomic status, housing conditions, and interactions with those living in the home, are strongly associated with child health and have been suggested to alter -omics. Our aim was to review and understand the biological pathways by which home factors contribute to child neurodevelopment outcomes. We review studies suggestive of the home factors contributing to neurodevelopmental outcomes that encompass the hypothalamic-pituitary-adrenal axis, the brain, the gut-brain-axis, and the immune system. We thus conceptualize home-ics as the study of how the multi-faceted living environment can impact neurodevelopmental outcomes through biology and highlight the importance of targeting the modifiable aspects of a child's home to optimize outcomes. We encourage clinicians and health care providers to routinely assess home factors in patient encounters, and counsel families on modifiable aspects of the home. We conclude by discussing clinical and policy implications and future research directions of home-ics. IMPACT: Home-ics can be conceptualized as the study of how home factors may shape child neurodevelopmental outcomes through altering biology. Targeting modifiable aspects of a child's home environment (e.g. parenting style, early intervention, enriched environment) may lead to improved neurodevelopmental outcomes. Clinicians should routinely assess home factors and counsel families on modifiable aspects of the home.

The effect of nutritional risk management program on the growth and development of infants and toddlers with congenital heart disease after discharge

Objective

To evaluate the effect of nutritional risk management program on the growth and development of infants and toddlers with congenital heart disease (CHD) after discharge.

Methods

Infants and toddlers with CHD discharged from a children's specialized hospital in southeast China were selected as the research subjects. The subjects were divided into the intervention group and the control group. The intervention group underwent a nutritional risk management program combined with traditional follow-up after discharge, whereas the control group received traditional follow-up after discharge. The primary outcome measure were the height-for-age Z-score (HAZ), weight-for-age Z-score (WAZ), and weight-for-height Z-score (WHZ) at different time point and the percentage of growth and development curves were also recorded and analyzed.

Results

There were no statistically significant differences in general characteristics between the two groups. However, in the intervention group, the percentages of HAZ < -2, WAZ < -2, and WHZ < -2 were lower than those in the control group at 3rd and 6th months after discharge (P < 0.05). The percentage of growth and development curves (3%-97%) was higher than that in the control group (P < 0.05). The readmission rate within 6 months after discharge in the intervention group was lower than that in the control group (P < 0.05).

Conclusion

Implementing nutritional risk management program for infants and toddlers with CHD after discharge can help improve postoperative malnutrition, promote growth and development and achieve catch-up growth as soon as possible.