Research Article
Volume 7 Issue 2 - 2020
Role of Malnourishment, Anaemia and Hypoproteinemia in Children as Risk factors in Intracardiac Repair for Tetralogy of Fallot
Sreemathi Seshadrinathan*, Gopal Karunanidhi Jaikaran and Muthu Vijayasankar
Department of Cardio-Vascular and Thoracic Surgery, Public Health Centre, Chennai, India
*Corresponding Author: Sreemathi Seshadrinathan, Department of Cardio-Vascular and Thoracic Surgery, Public Health Centre, Chennai, India.
Received: December 17, 2019; Published: January 30, 2020




Abstract

Introduction: Malnourishment, anaemia and hypoproteinaemia (MAH) in underprivileged children as risk factors for Intra cardiac Repair for Tetralogy of Fallot have been studied globally. Determination of their role in the outcome in India is the goal of this retrospective analysis. Biomarkers for outcome are mortality and morbidity. 

Materials and Methods: 750 Patients under 12yrs who underwent Intracardiac Repair for TOF in 3 centres between 1988 to 2019 were retrospectively analysed for Pre, intra, postoperative morphological and functional risk factors contributing to mortality and morbidity with special emphasis on malnourishment, anaemia and hypoproteinaemia. Data were analysed in 3 Chronological phases- 1988 - 2002, 2002 - 2013 and 2013 - 2019. Collaboration with Children’s Hospital Boston divided first phase into Pre and Post IQIC. (International Quality Improvement Collaborative for Congenital Heart Disease). In the 2nd Stage of 1st Phase mortality reduced from 12% to 2% and Morbidity from 14% to 2%. Malnourishment was treated in the first phase with Ryle’s tube and parenteral feeding before weaning from mechanical ventilation. Intra operative treatment of anaemia with hemic prime, reduced prime in the pump and decreased CPBP tubing lengths, hemofilter and postoperative treatment with blood products and whole fresh blood were effective. Hypoproteinaemia was treated with addition of albumin to the prime and plasma postoperatively.

Results: Analysis was for 3 phases in 3 centres. They were divided on the basis of state of Art equipment, trained, dedicated team and hospital with Paediatric multi specialties. First phase evolved from optimal infrastructure to State - of - Art. Second had optimal infrastructure and the 3rd had all three. 60% were between 1 - 5yrs and 25% below 1 year. 50% weighed between 10 - 15 Kgs. There was a preponderance of males. Malnourishment was in 87%, anaemia in 70%, hypoproteinaemia in 60%. Surgical era decided mortality due MAH - 12% in the first part of first phase became less than 2% in the phase. There was one morbidity in the 2nd phase and no mortality or morbidity in the 3rd phase. 23 other risk factors were analysed. Median Length of stay in ICU was 12 days (10 - 29 days). Median duration of mechanical ventilation was 96 hrs (48 - 120 hrs). While, RACH1 classification, residual RVOT obstruction, postoperative RV Function, myocardial protection, long CPBP time, ACC time, played important roles in the outcome, gross mortality for intracardiac repair is now 3%. (MAH) did not contribute to mortality in the second and Third phases. There was a strong correlation between morbidity, preoperative respiratory infection and postoperative infection, Morphological and functional characteristics influenced morbidity. 

Conclusion: MAH in the early part of the First phase contributed to postoperative mortality 12%. It reduced to 2% in the second stage. Anaemia and hypoproteinemia (AH) when managed intra and post operatively, did not contribute to mortality in the second and third phases. There was one case in the 2nd phase that contributed to morbidity. In the 3rd phase, there were no mortality or morbidity.

Keywords: TOF; Malnourishment; Anaemia; Hypo Proteinemia; Mortality; Morbidity; Risk Factors

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Citation: Sreemathi Seshadrinathan., et al. “Role of Malnourishment, Anaemia and Hypoproteinemia in Children as Risk factors in Intracardiac Repair for Tetralogy of Fallot”. EC Cardiology 7.2 (2020): 01-10.

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