Original article
Somatic growth after ventricular septal defect in malnourished infants

https://doi.org/10.1016/j.jpeds.2006.04.012Get rights and content

Objective

To assess somatic growth after ventricular septal defect (VSD) repair in severely malnourished infants.

Study design

Ninety consecutive infants (age at surgery: 7.2 ± 3.2 months) were followed after VSD closure at a referral center in southern India to evaluate somatic growth.

Results

At surgery, 44% and 30% of patients had weight and height Z score <−3, respectively. On follow-up (age 5.4 ± 0.8 years), despite a significant improvement from baseline (Z score −1.8 ± 1.2 vs −2.8 ± 1.3, P <.001), weight was significantly lower compared with healthy Indian children, particularly for boys. Height Z score improved significantly only in girls (−0.8 ± 1.3 vs −1.8±2.1, P = .01). Weight, height, and combined weight and height Z scores (failure to thrive) of <−2 were observed in 42%, 27%, and 18 % of patients, respectively. On multivariate analysis, weight Z score <−2 on follow-up was predicted by weight Z score at surgery and male sex, height Z score <−2 by maternal height and male sex, and failure to thrive by maternal height and caloric intake.

Conclusions

There is suboptimal recovery of somatic growth after repair of VSD in severely malnourished infants. Preoperative malnutrition affected only weight on follow-up, whereas height recovery and failure to thrive were influenced by constitutional factors.

Section snippets

Study Design

The study was a follow-up analysis of somatic growth characteristics of the survivors from a group of 100 consecutive infants with a single large VSD, multiple VSDs, or a double outlet right ventricle who underwent surgical closure of VSD(s) as the primary procedure at our institute between July 1998 and June 2000.

Setting

The study was conducted in the setting of a tertiary care referral hospital serving a population of 30 million people in the state of Kerala in southern India. Reference growth data

Baseline Characteristics

Four of these 94 eligible patients (4%) were lost to follow-up. There was no difference in the preoperative clinical characteristics of the patients who were lost to follow-up compared with those with follow-up data.

The baseline (at the time of surgery) characteristics of the 90 patients with follow-up data and the details of follow-up are presented in Table I. The mean duration of follow-up for all patients was 52.3 ± 15.5 months. Fifty-one (57%) patients were boys. Nine (10 %) patients had

Discussion

We found that recovery of somatic growth is suboptimal in infants with severe preoperative malnutrition following corrective surgery for VSD. For both boys and girls, weight on follow-up was significantly lower when compared with healthy children from the same geographical area, and for boys, height was also significantly lower. However, there was notable improvement from the time of surgery, particularly in weight gain.

An analysis of the factors associated with suboptimal recovery of somatic

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