الفهرس 
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Abstract
Congenital heart diseases (CHD) are the most common congenital malformation in pediatrics. These heart defects usually cause changes in development, mainly in height and weight, which when measured are shown below the normal mean for age (Amorim LFP et al., 2008). These changes are usually multifactorial and may be from both cardiac and extra-cardiac causes (Vieira TCL et al., 2007).
Malnutrition is a common problem in this group of patients, irrespective of different types of congenital heart disease. The severity of malnutrition can range from mild under-nutrition to failure to thrive . It is a common cause of morbidity in children with congenital heart disease (Mitchell IM et al., 1995). The preoperative malnutrition may increase the risk of postoperative morbidity, increase hospital length of stay (LOS), and delay recovery (Toole BJ et al., 2014).
The major advancement in corrective cardiac interventions improved patient survival and nutritional status by reducing morbidity and energy expenditure and increasing food consumption (Bravo-Valenzuela NJM et al., 2011). Normalization of somatic growth has been documented in developed countries, when corrective intervention for congenital heart disease is performed early (Cheung MM et al., 2003). Due to resource limitations, suboptimal recovery in developing countries has been obtained, when corrective interventions are performed late (Kumar RK and Tynan MJ, 2005).
Eventually, the delay in correction of congenital heart disease can lead to growth retardation and worsening in nutritional status. The significant improvement of growth and nutritional status on short-term follow-up after correction of congenital heart disease reinforces the importance of earlier corrective cardiac interventions (Vaidyanathan B et al., 2008).
This prospective observational study was conducted at the pediatric cardiac catheterization unit in Sohag university hospital from October, 2016 to September, 2017, on 102 participants with congenital heart disease (mean of age: 3.95±3.11 years), 42 (41.18%) of them were males, diagnosed by echocardiography before and admitted for therapeutic cardiac catheterization.
We performed a clinical analysis and reviewing the data of these 102 participants having congenital heart diseases, with special consideration for the age, sex, family history of congenital heart disease, type of congenital heart defect, type of recommended therapeutic catheterization, anthropometric parameters before therapeutic catheterization that included weight for age z-score (WAZ), height for age z-score (HAZ), upper arm circumference and body mass index, and the nutritional status of them before catheterization that was assessed according to the WHO Anthro program of the World Health Organization.
These participants undergoing therapeutic cardiac catheterization were subjected to the follow-up of their anthropometric parameters as mentioned above and nutritional status at one, three and six months after catheterization by the same doctor in our outpatient clinic; and finally the data was analyzed by SPSS software.
In the present study, we found that in the follow-up period of six months after therapeutic cardiac catheterization, there was a significant weight recovery which was reflected in the improvement of these parameters: weight for age z-score (WAZ), upper arm circumference and
body mass index, comparing the beginning and the end of the study. This recovery starts early during the first six months after catheterization, which would influence the haemodynamic correction, allowing a better dietary intake and nutrient utilization.
Nevertheless, we found that there was no recovery in height between admission and six months after, which was reflected in the insignificant difference in the parameter of height for age z-score (HAZ), and that was consistent with other international studies. While regarding malnutrition, we found a high percentage of malnutrition in children with congenital heart disease at the time of catheterization. Its patterns were underweight and stunting but the underweight pattern was more obvious in the present study.
During the follow-up, we found a nutritional recovery in relation to weight gain which was reflected in the significant decline in the percentage of underweight pattern and the increase in percentage of normal nutritional status at the 6th month follow-up, but this did not occur in height recovery which was reflected in the unremarkable decrease in percentage of stunting at all times of follow-up, which was consistent with other international studies. However, the malnourished patients with congenital heart disease received the most benefits from the catheterization, increasing their weight and improving nutritional status within the first six months.
Pediatric patients with congenital heart disease are prone to malnutrition and growth failure. Therapeutic cardiac catheterization has a significant and positive effect on weight gain and nutritional status in patients with congenital heart disease.
Major limitations of the study :
Our study was observational and designed to determine the effect of corrective internention on somatic growth in children with congenital heart disease. However, we can not speculate on the true achievement of normal somatic growth potential postoperatively, because variables like birth weight and mid parental height were not assessed, which are known as aggravating factors in height and weight development. Other studies are necessary to determine the possible factors that contribute to postoperative catch-up growth.
In our study, therapeutic cardiac catheterizations were only performed and this type of cardiac intervention is known for correction of simple acyanotic heart defects. Therefore, the patients with complex forms of congenital heart disease that have more severe malnutrition, are not included. In addition, the haemodynamic or clinical variables such as pulmonary hypertension, cyanosis and congestive heart failure were not present in our participants, which are also known as aggravating factors in height and weight recovery.
We also faced some limiting factors regarding lack of material potential where the devices for ventricular septal defect closure were not available by large numbers at the time of study, and period of growth follow-up which was six months only after catheterization. As already known, ventricular septal defect is the most common congenital heart disease and causes more symptoms affecting growth than other acyanotic heart defects. In addition, longer follow-up is needed to provide more details about long-term somatic growth.
Recommendation:
Energy malnutrition due to low caloric intake is easily preventable and should be addressed more energetically. Optimal growth may be possible
even for the chronically ill child if adequate calories are provided and early corrective intervention is performed before severe malnutrition develops. Preventive actions can be taken by growth monitoring, providing free dietary counseling and dietary supplements especially for patients with a higher risk of malnutrition and for those living in impoverished and deprived conditions.
Therefore, based on this study, we recommend informing pediatricians about the importance of aggressive nutritional supplementation for children with congenital heart disease, while efforts at early definitive corrective interventions including therapeutic cardiac catheterization or surgery should be intensified for normalization of somatic growth and improving the nutritional status.