PURPOSE: Malnutrition and failure to thrive have long been recognized as common systemic consequences of congenital heart disease(CHD). But there is little data about the prevalence and severity of malnutrition with CHD in Korea. We designed this study to determine the prevalence of malnutrition among hospitalized children with CHD. METHODS: We reviewed 100 hospitalized children with CHD who were randomly selected from consecutive admissions at department of pediatrics and thoracic surgery of Asan Medical Center from Jul. 1998 to Jun. 1999. A cross-sectional, retrospective study was done. Acute malnutrition was determined by calculating a ratio of the children's weight to the mean weight for the children's height. Chronic malnutrition was assessed by obtaining a ratio of the children's height to the mean height for the children's age. According to these criteria, malnutrition is divided into mild, moderate, and severe categories. RESULTS: Acute and chronic malnutrition occurred in 39% and 31% of the children, respectively. Age, diagnosis, and symptoms were analysed with the presence of the malnutrition. Forty nine percent of infants diagnosed as suffering from acute malnutrition, and cyanosis appear to be the ones the most severely important factor(P<0.001). Cyanotic children with pulmonary hypertension are the ones most severely affected(P<0.001). Acute or chronic malnutrition occurred in more than 44% of children with cyanosis and/or congestive heart failure but in only 11% of children with neither(P<0.001). CONCLUSION: Malnutrition in CHD is relatively high. We suggest nutritional screening and intervention for the children with CHD should be considered.
Child ; Child Nutrition Disorders* ; Child, Hospitalized ; Chungcheongnam-do ; Cyanosis ; Diagnosis ; Failure to Thrive ; Heart ; Heart Defects, Congenital* ; Heart Failure ; Humans ; Hypertension, Pulmonary ; Infant ; Korea ; Malnutrition* ; Mass Screening ; Pediatrics ; Prevalence ; Retrospective Studies ; Thoracic Surgery

OBJECTIVE:The purpose of this study was to compare the sensitivity of proton Magnetic Resonance Spectrography (MRS) for estimating absolute metabolite concentrations and ratio of fetal brains. METHODS:Between September 2005 and August 2006, our study was prospective single center trial and included 39 healthy women (Group 1: fetuses with risk factor of fetal distress or hypoxic damage [n=15], Group 2: fetal CNS anomalies on ultrasound [n=12], Group 3: normal fetuses [n=12]). We quantified resonances for the main proton MRS-detectable brain and calculated metabolite ratios of the three groups. We compared the obtained metabolite levels of the three groups with electronic fetal cardiotocography, Doppler ultrasound examination, Apgar score, and umbilical artery blood gas analysis. RESULTS:Abnormal amniotic fluid, abnormal Doppler studies, and abnormal cardiotocograms were significantly more prevalent in Group 1 compared with those of Group 2 and 3. In Group 1, choline (Cho) levels (7.86+/-3.51mmol/L) were significantly higher than in Group 2 or 3 (p=0.024). The ratios of N-acetylasparate (NAA)/creatinine-phosphocreatine (Cr) and Cho/Cr were increased whereas the ratios of NAA/Cho, lactate (Lac)/Cho, Lac/NAA, and Lac/Cr were decreased; however, there was no statistical significance. In patients who have oligohydramnios and absence of umbilical diastolic flow, choline and N-acetylasparate levels were significantly elevated (p<0.05, p<0.05, respectively). But, MRS metabolites and ratios showed no significant differences for low Apgar scores, umbilical arterial academia, uterine artery notching, maternal blood pressure or abnormal fetal cardiotocograms. CONCLUSION:This study demonstrates the possibility of performing proton MRS to assess the metabolic information of the fetal brain. Further technical progress may be useful of improving the degree of detection of hypoxic changes or an impending hypoxic state for prenatal diagnosis.
Amniotic Fluid ; Apgar Score ; Blood Gas Analysis ; Blood Pressure ; Brain* ; Cardiotocography ; Choline ; Female ; Fetal Distress ; Fetus ; Humans ; Lactic Acid ; Magnetic Resonance Spectroscopy* ; Oligohydramnios ; Pregnancy ; Prenatal Diagnosis ; Prospective Studies ; Protons* ; Risk Factors ; Ultrasonography ; Umbilical Arteries ; Uterine Artery