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8/13/2019 Jurnal Belle
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JOURNAL
Malnutrition and growth failure in cyanotic and
acyanotic congenital heart disease with and
without pulmonary hypertension
Perceptor :
dr. Manan Affandi, Sp.A
dr. Rachmat Gumelar, Sp.A
dr. Tina Ramayanthi, Sp.A Bellinda Nadya Putri 1102007059
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Abstract
Aim : To investigate the effect of several types of congenital
heart disease (CHD) on nutrition and growth
Patients : Malnutrition and growth failure was investigated in
89 patients with CHD aged 1-45 months and they were
according to cardiac diagnosis : cyanotic with pulmonal
hypertension (cP), cyanotic without pulmonal hypertension
(cp), acyanotic with pulmonal hypertension (aP) and
acyanotic without pulmonal hypertension (ap)
Methods : - Using standard measurements of weight, length
and head circumference, for physical signs of malnutrition
(skin lesions, thin and weak hair) were made by one nurse
- Interview with patients’ parents
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Results :There was no significant difference between groups in term of
parental education status, sosioeconomic level, duration of breast
feeding, and number of siblings
Group cP (cyanotic patients with pulmonary hypertension) including to
moderate to severe malnutrition
Group aP (acyanotic patients with pulmonary hypertension) including
to mild or borderline malnutrition
Group cp (cyanotic patients without pulmonary hypertension) normalin nutritional state
Conclusions: Patients with CHD are prone to malnutrition and growth
failure. Pulmonary hypertension appears to be the most important
factor, and cyanotic patients with pulmonary hypertension are theones most severely affected
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Background of the Study
WHO defines malnutrition as the cellular
imbalance between the supply of nutrients
and energy and the body’s demand for
them to ensure growth, maintenance, and
specific functions
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Patients & Methods
• 89 patients with cardiac diagnosis
• Patients were assigned to four groups (aP, ap, cP, and
cp)
• Information on sosioeconomic level, education status of
the parents, patients’ birth weight, nutrition hystory by
interview with patients’ parents
• Standardised measurements by one nurse for physical
examination, checking their weight, length, head
circumference, and physical signs of malnutrition (skinlesions, thin and weak hair)
• Measurements of pulmonary artery pressure, pulmonary
vasculary resistence index, aortic oxygen saturation,
haemoglobin, albumin and venous pH
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Results
• Low family sosioeconomic level may have
contributed in the causing of this disease
• Cyanotic patients without pulmonary
hypertension were normal weight for their lengthor were mildly malnourished (88%), 48% were
stunted, and 40% failure to thrive
• Cyanotic patients with pulmonary hypertension
were the most severely affected, 81% having
malnutrition, 56% having moderate to severe
malnutrition, 56% failure to thrive
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Discussion
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What is the importance of
nutrition support in patients
with congenital heart disease ?
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Incidence of Malnutrition in CHD
• Patients with CHD there is an in the
frequency and severity of acute / chronic
malnutrition
• Failure to thrive in infants with CHD
• Aggressive nutrition intervention is vital to
prevent unsuccessful outcomes
associated with malnutrition
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Etiology of Malnutrition
• Inadequate caloric intake
• Increased energy expenditure due to
increased respiratory rate and/or increase
metabolic rate
• Effects of hypoxia on cellular metabolism
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Energy Expenditure
• Decreased rates of weight gain in group
with CHD
• 49% of study population with inadequate
intake due to fatigue and tachypnea
• Cyanotic patients with pulmonary
hypertension severely affected with
malnutrition
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Conclusion
In this study shows the additive effects of
hypoxia and pulmonary hypertension on
nutrition and growth of children with CHD
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