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Ann Saudi Med 27(6) November-December 2007 www.saudiannals.net 461 To the Editor: Congenital heart diseases (CHD) may affect the growth of children and lead to maln nutrition. The speed of growth is more rapid during the first three years and nutritional needs are greatest at this point. These years are a critical period for future cognitive ability. The treatment of emergency problems in children with CHD needing surgery are a priority, but nutritional restoration usually does not take place in these protocols. In the preoperative period, 24 children with CHD hospitalized for cardiac or secondary pulmonary problems were evaluated. Subjects were children younger than two years of age. Znscores for weight and height were calculated using data from percentile charts for Turkish children. Wasting criteria, stunting criteria and Wellcome scores were used to evaluate nutritional status. Waterlaw’s scores define the stages of acute and chronic nutritional stan tus and include growth stunting and wasting. Cyanotic and nonncyanotic cases were compared. Half of the patients were female. The average birthweight was 2932±603 gram, the average age was 10.19±1.12 months, weight was 5951±2201 grams and height was 63.7±8.5 centimeters. Of these cases, 21 had a normal birthweight for gestational age and three had low birthweight. When we evaluated the patients for proteinnenergy malnutrition, the severely acute malnutrition ratio with wasting was 66.6% and chronn ic malnutrition according to growth stunting was 83.3%. Out of 24 pan tients, 33.3% (n=8) were diagnosed with marasmus by Wellcome scores (Table 1). Preoperative nutritional parameters in children with congenital heart dise eases under two years of age Malnutrition is the most imn portant risk factor in mortality and morbidity in childhood. It affects life quality of children negatively. Its detection and treatment are imn portant components in the clinical management of many conditions.1 We also believe that the nutritional evaluation of children with CHD is often ignored during the first admisn sion. Hornbya et al suggest that inn corporating simple anthropometric and functional measurement into protocols of nutritional assessment for patients with CHD can identify patients at risk.1 Cardiac malformations may be responsible for malnutrition and the degree of malnutrition is related to hemodynamic status.2 Based on these data, children with CHD were classified as cyanotic or nonncyanotn ic. Chronic malnutrition is a comn mon and serious problem in infants with CHD and was more common in cyanotic patients (92.3%) than in nonncyanotic patients (72.7%). Nearly all of the cyanotic patients were affected by acute and chronic malnutrition and their Znscores for both weight and height were under –2 SD. Chronic malnutrition was more severe in children with CHD below 2 years of age.3 Daily energy expenditure was also higher in chiln dren with CHD between 2 and 8 months of age.4 In some studies, symptomatic infants (73%) had higher rates of chronic malnutrition than asympn tomatic infants (46%) and the pern centile scores of cyanotic CHD pan tients were lowest.5 Among children hospitalized with CHD, the rates of acute and chronic malnutrition were 33% and 64%, respectively.6 In patients with cyanotic CHD and/or congestive heart failure (CHF), acute or chronic malnutrin tion occurs in 70%. The rate was 30% among noncyanotic patients without CHF.6 In our study, it was determined that the younger the patients were, the worse their maln nutrition. In another study, hypoxia and pulmonary hypertension were

Preoperative nutritional parameters in children with congenital heart diseases under two years of age