ABSTRACT
INTRODUCTION: The prevalence of malnutrition among infants with congenital heart disease (CHD) is high. Early nutritional assessment and intervention contribute significantly to its treatment and improve outcomes. Our objective was to develop a consensus document for the nutritional assessment and management of infants with CHD. MATERIAL AND METHODS: We employed a modified Delphi technique. Based on the literature and clinical experience, a scientific committee prepared a list of statements that addressed the referral to paediatric nutrition units (PNUs), assessment, and nutritional management of infants with CHD. Specialists in paediatric cardiology and paediatric gastroenterology and nutrition evaluated the questionnaire in 2 rounds. RESULTS: Thirty-two specialists participated. After two evaluation rounds, a consensus was reached for 150 out of 185 items (81%). Cardiac pathologies associated with a low and high nutritional risk and associated cardiac or extracardiac factors that carry a high nutritional risk were identified. The committee developed recommendations for assessment and follow-up by nutrition units and for the calculation of nutritional requirements, the type of nutrition and the route of administration. Particular attention was devoted to the need for intensive nutrition therapy in the preoperative period, the follow-up by the PNU during the postoperative period of patients who required preoperative nutritional care, and reassessment by the cardiologist in the case nutrition goals are not achieved. CONCLUSIONS: These recommendations can be helpful for the early detection and referral of vulnerable patients, their evaluation and nutritional management and improving the prognosis of their CHD.
Subject(s)
Heart Defects, Congenital , Malnutrition , Infant , Child , Humans , Consensus , Nutritional Status , Nutritional Support , Malnutrition/diagnosis , Heart Defects, Congenital/complications , Heart Defects, Congenital/therapy , Heart Defects, Congenital/diagnosisABSTRACT
Evidence on the impact of MCS on pediatric heart transplant survival is still scarce related to congenital heart disease patients including univentricular physiology as well as the risk factors for complications. We performed a retrospective review of all urgent pediatric (aged ≤16 years) HT from 2004 to 2014 in the Spanish Pediatric Heart Transplant Registry Group. Patients were stratified into two groups: urgent 0 (MCS at HT) and urgent 1 (non-MCS at HT). The primary outcome measure was post-transplant survival; secondary outcome measures were complications and absence of infections and rejection during the first post-transplant year. One hundred twenty-one pediatric patients underwent urgent HT, 58 (47.9%) urgent 0 and 63 (52%) urgent 1. There were 30 (24.8%) deaths: 12 in the urgent 0 group and 18 in the urgent 1 group, P = n.s. Regarding the type of MCS, patients on ECMO had the highest rate of complications (80%) and mortality (40%). Patients in the urgent 1 group showed a higher risk of hospital re-admission for infection during the first year after transplantation (OR 2.31 [1.1-4.82]), P = .025. We did not identify a risk factor for mortality. MCS does not impact negatively on survival after HT. However, there is a significant increase in 30-day and 1-year mortality and complications in ECMO patients compared with VAD patients. Infants, congenital heart disease, and PediMACS were not found to be risk factors for mortality.
Subject(s)
Heart Defects, Congenital/surgery , Heart Transplantation , Heart-Assist Devices , Postoperative Complications/mortality , Child , Child, Preschool , Female , Humans , Male , Retrospective Studies , Survival RateABSTRACT
Desde el primer trasplante cardiaco pediátrico llevado a cabo en España en 1984 hasta el momento, se han realizado 379 trasplantes en menores de 16 años. Durante este tiempo, el Registro Español de Trasplante Cardiaco ha supuesto una herramienta esencial a través de la cual hoy podemos conocer las características clínicas, los resultados y el pronóstico del trasplante cardiaco pediátrico en nuestro país. El objetivo de este informe es describir las características clínicas, el tratamiento inmunosupresor, las complicaciones agudas y tardías y el pronóstico de los menores de 16 años receptores de un trasplante cardiaco (AU)
Since the first pediatric heart transplantation was performed in Spain in 1984, there have been 379 transplantations in children aged under 16 years in the country. Throughout this time, the Spanish Heart Transplantation Registry has proved to be a vital resource such that today we have a good understanding of the clinical characteristics, results and prognostic implications of pediatric heart transplantation nationally. The aim of this report was to describe the clinical characteristics of, immunosuppressive therapy and acute and late complications in, and the prognosis of patients aged under 16 years who have undergone heart transplantation in Spain (AU)
