Factors Associated with Congenital Heart Disease in Severely Malnourished Children under Five and Their Outcomes at an Urban Hospital, Bangladesh
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Site
2.2. Study Population and Design
2.3. Patient Management
2.4. Measurements
2.5. Statistical Analysis
3. Results
Variables | Cases (n = 64) | Comparisons (n = 630) | OR | 95% CI | p-Value |
---|---|---|---|---|---|
Male sex | 41 (64) | 386 (61) | 1.12 | 0.66–1.92 | 0.660 |
Age in months | 8.0 (5.0, 12.0) | 10.0 (5.0, 16.0) | - | - | 0.180 |
Working mother | 4 (6) | 83 (13) | 0.43 | 0.15–1.23 | 0.100 |
Breastfeeding | 48 (75) | 448 (71) | 1.19 | 0.66–2.15 | 0.560 |
Residence in slum | 3 (5) | 73 (12) | 0.37 | 0.11–1.22 | 0.090 |
BCG vaccination | 57 (89) | 554 (88) | 1.11 | 0.49–2.53 | 0.790 |
Diarrhea | 48 (75) | 560 (89) | 0.37 | 0.20–0.69 | 0.001 |
Dehydration | 7 (14) | 104 (18) | 0.74 | 0.32–1.71 | 0.490 |
Cough | 61 (95) | 295(47) | 23.10 | 7.17–74.36 | <0.001 |
Respiratory distress | 46 (72) | 128 (20) | 10.02 | 5.62–17.87 | <0.001 |
Lethargy | 3 (5) | 12 (2) | 2.53 | 0.69–9.22 | 0.140 |
Convulsion | 1 (2) | 4 (1) | 2.48 | 0.27–22.56 | 0.400 |
Cyanosis | 3 (5) | 1 (0.2) | 30.93 | 3.17–301.9 | <0.001 |
Pedal edema | 1 (2) | 52 (8) | 0.17 | 0.02–1.29 | 0.054 |
Grunting | 6 (9) | 32 (5) | 1.93 | 0.77–4.81 | 0.150 |
Hypoxemia | 19 (30) | 26 (4) | 9.80 | 5.05–19.07 | <0.001 |
Hypoglycemia | 5 (8) | 9 (1) | 5.85 | 1.90–18.01 | <0.001 |
Hypernatremia | 9 (14) | 44 (7) | 2.17 | 1.01–4.70 | 0.040 |
Hyponatremia | 4 (6) | 334 (53) | 0.06 | 0.02–0.16 | <0.001 |
Hyperkalemia | 15 (23) | 347 (55) | 0.25 | 0.13–0.45 | <0.001 |
Hypokalemia | 7 (11) | 89 (14) | 0.75 | 0.33–1.69 | 0.480 |
Radial pulse | 142.4 ± 15.4 | 137.0 ± 9.4 | - | 2.79–8.02 | <0.001 |
Respiratory rate | 52.6 ± 10.5 | 42.8 ± 9.8 | - | 7.05–12.49 | <0.001 |
Total WBC count Duration of hospitalization | 13,570 (10,615, 18,420) 6.0 (4.0, 9.0) | 14,110 (11,050, 18,720) 4.0 (3.0, 8.0) | - - | - - | 0.843 0.001 |
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- McGuire, S.; WHO; World Food Programme and International Fund for Agricultural Development. The State of Food Insecurity in the World 2012. Economic growth is necessary but not sufficient to accelerate reduction of hunger and malnutrition. Adv. Nutr. 2013, 4, 126–127. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Bhutta, Z.A.; Salam, R.A. Global Nutrition Epidemiology and Trends. Ann. Nutr. Metab. 2012, 61, 19–27. [Google Scholar] [CrossRef] [PubMed]
- Haddad, L.J.; Hawkes, C.; Achadi, E.; Ahuja, A.; Ag Bendech, M.; Bhatia, K.; Bhutta, Z.; Blossner, M.; Borghi, E.; Eriksen, K.; et al. Global Nutrition Report 2015: Actions and Accountability to Advance Nutrition and Sustainable Development; International Food Policy Research Institute: Washington, DC, USA, 2015. [Google Scholar]
- Collins, S.; Dent, N.; Binns, P.; Bahwere, P.; Sadler, K.; Hallam, A. Management of severe acute malnutrition in children. Lancet 2006, 368, 1992–2000. [Google Scholar] [CrossRef]
- Abu-Harb, M.; Wyllie, J.; Hey, E.; Richmond, S.; Wren, C. Presentation of obstructive left heart malformations in infancy. Arch. Dis. Child.-Fetal Neonatal Ed. 1994, 71, F179–F183. [Google Scholar] [CrossRef] [Green Version]
- Uzun, O.; Kennedy, J.; Davies, C.; Goodwin, A.; Thomas, N.; Rich, D.; Thomas, A.; Tucker, D.; Beattie, B.; Lewis, M.J. Training: Improving antenatal detection and outcomes of congenital heart disease. BMJ Open Qual. 2018, 7, e000276. [Google Scholar] [CrossRef] [Green Version]
- Bouma, B.J.; Mulder, B.J.M. Changing Landscape of Congenital Heart Disease. Circ. Res. 2017, 120, 908–922. [Google Scholar] [CrossRef] [PubMed]
- Chowdhury, F.; Bin Shahid, A.S.M.S.; Ghosh, P.K.; Rahman, M.; Hassan, M.Z.; Akhtar, Z.; Muneer, S.M.-E.; Shahrin, L.; Ahmed, T.; Chisti, M.J. Viral etiology of pneumonia among severely malnourished under-five children in an urban hospital, Bangladesh. PLoS ONE 2020, 15, e0228329. [Google Scholar] [CrossRef] [PubMed]
- Chisti, M.J.; Salam, M.A.; Ashraf, H.; Faruque, A.S.G.; Bardhan, P.K.; Hossain, I.; Shahid, A.S.M.S.B.; Shahunja, K.M.; Das, S.K.; Imran, G.; et al. Clinical Risk Factors of Death From Pneumonia in Children with Severe Acute Malnutrition in an Urban Critical Care Ward of Bangladesh. PLoS ONE 2013, 8, e73728. [Google Scholar] [CrossRef] [PubMed]
- Ahmed, T.; Ali, M.; Ullah, M.M.; Choudhury, I.A.; Haque, M.E.; Salam, M.A.; Rabbani, G.H.; Suskind, R.M.; Fuchs, G.J. Mortality in severely malnourished children with diarrhoea and use of a standardised management protocol. Lancet 1999, 353, 1919–1922. [Google Scholar] [CrossRef]
- World Health Organization. Pocket Book of Hospital Care for Children: Guidelines for the Management of Common Childhood Illnesses; World Health Organization: Geneva, Switzerland, 2013. [Google Scholar]
- Asmsb, S.; Alam, T.; Shahrin, L.; Shahunja, K.M.; Sarmin, M.; Afroze, F.; Rahman, M.W.; Faruque, A.; Ahmed, T.; Chisti, M.J. Early management of hypokalaemia in severely malnourished children under five could help to reduce deaths in developing countries. Acta Paediatrica (Oslo, Norway: 1992) 2020, 110, 1658–1664. [Google Scholar]
- Levy, M.M.; Dellinger, R.P.; Townsend, S.R.; Linde-Zwirble, W.T.; Marshall, J.C.; Bion, J.; Schorr, C.; Artigas, A.; Ramsay, G.; Beale, R.; et al. The Surviving Sepsis Campaign: Results of an international guideline-based performance improvement program targeting severe sepsis. Intensive Care Med. 2010, 36, 222–231. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Chowdhury, F.; Ghosh, P.K.; Shahunja, K.M.; Shahid, A.S.M.S.B.; Shahrin, L.; Sarmin, M.; Sharifuzzaman; Afroze, F.; Chisti, M.J. Hyperkalemia Was an Independent Risk Factor for Death While Under Mechanical Ventilation Among Children Hospitalized With Diarrhea in Bangladesh. Glob. Pediatr. Heal. 2018, 5, 2333794X17754005. [Google Scholar] [CrossRef] [Green Version]
- Kirk, R.; Dipchand, A.I.; Rosenthal, D.N.; Addonizio, L.; Burch, M.; Chrisant, M.; Dubin, A.; Everitt, M.; Gajarski, R.; Mertens, L.; et al. Erratum: The international society of heart and lung transplantation Guidelines for the management of pediatric heart failure: Executive summary. J. Heart Lung Transplant. 2014, 33, 1104. [Google Scholar] [CrossRef]
- Kortz, T.B.; Axelrod, D.M.; Chisti, M.J.; Kache, S. Clinical outcomes and mortality before and after implementation of a pediatric sepsis protocol in a limited resource setting: A retrospective cohort study in Bangladesh. PLoS ONE 2017, 12, e0181160. [Google Scholar] [CrossRef] [Green Version]
- Suskind, D.; Murthy, K.K.; Suskind, R.M. The malnourished child: An overview. Nestle Nutr. Workshop Ser. (USA) 1990, 19, 1–22. [Google Scholar]
- Golden, M.H. Oedematous malnutrition. Br. Med Bull. 1998, 54, 433–444. [Google Scholar] [CrossRef] [Green Version]
- Cabalka, A.K. Physiologic risk factors for respiratory viral infections and immunoprophylaxis for respiratory syncytial virus in young children with congenital heart disease. Pediatr. Infect. Dis. J. 2004, 23, S41–S45. [Google Scholar] [CrossRef]
- Chisti, M.J.; Ahmed, T.; Faruque, A.S.G.; Salam, M.A. Clinical and laboratory features of radiologic pneumonia in severely malnourished infants attending an urban diarrhea treatment center in bangladesh. Pediatr. Infect. Dis. J. 2010, 29, 174–177. [Google Scholar] [CrossRef]
- Morgan, G. What, if any, is the effect of malnutrition on immunological competence? Lancet 1997, 349, 1693–1695. [Google Scholar] [CrossRef]
- Chisti, M.J.; Ahmed, T.; Bardhan, P.K.; Salam, M.A. Evaluation of simple laboratory investigations to predict fatal outcome in infants with severe malnutrition presenting in an urban diarrhoea treatment centre in Bangladesh. Trop. Med. Int. Heal. 2010, 15, 1322–1325. [Google Scholar] [CrossRef] [PubMed]
- Hinton, R.B.; Ware, S.M. Heart Failure in Pediatric Patients with Congenital Heart Disease. Circ. Res. 2017, 120, 978–994. [Google Scholar] [CrossRef] [Green Version]
- Urso, C.; Brucculeri, S.; Caimi, G. Acid–base and electrolyte abnormalities in heart failure: Pathophysiology and implications. Hear. Fail. Rev. 2015, 20, 493–503. [Google Scholar] [CrossRef] [Green Version]
- Schrier, R.W.; Abraham, W.T. Hormones and Hemodynamics in Heart Failure. N. Engl. J. Med. 1999, 341, 577–585. [Google Scholar] [CrossRef] [PubMed]
- Schrier, R.W. Water and Sodium Retention in Edematous Disorders: Role of Vasopressin and Aldosterone. Am. J. Med. 2006, 119, S47–S53. [Google Scholar] [CrossRef] [PubMed]
- Stunnenberg, B.C.; Deinum, J.; Links, T.P.; Wilde, A.A.; Franssen, H.; Drost, G. Cardiac arrhythmias in hypokalemic periodic paralysis: Hypokalemia as only cause? Muscle Nerve 2014, 50, 327–332. [Google Scholar] [CrossRef]
- Odey, F.A.; Etuk, I.S.; Etukudoh, M.H.; Meremikwu, M.M. Hypokalaemia in children hospitalised for diarrhoea and malnutrition in Calabar, Nigeria. Niger. Postgrad. Med. J. 2010, 17, 19–22. [Google Scholar] [PubMed]
- Asmar, A.; Mohandas, R.; Wingo, C.S. A Physiologic-Based Approach to the Treatment of a Patient with Hypokalemia. Am. J. Kidney Dis. 2012, 60, 492–497. [Google Scholar] [CrossRef] [Green Version]
- Macdonald, J.E.; Struthers, A.D. What is the optimal serum potassium level in cardiovascular patients? J. Am. Coll. Cardiol. 2004, 43, 155–161. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. Guideline: Updates on the Management of Severe Acute Malnutrition in Infants and Children; World Health Organization: Geneva, Switzerland, 2013. [Google Scholar]
- Cohn, J.N.; Kowey, P.R.; Whelton, P.K.; Prisant, L.M. New guidelines for potassium replacement in clinical practice: A contemporary review by the National Council on Potassium in Clinical Practice. Arch. Intern. Med. 2000, 160, 2429–2436. [Google Scholar] [CrossRef]
- Gilger, M.; Jensen, C.; Kessler, B.; Nanjundiah, P.; Klish, W.J. Nutrition, growth, and the gastrointestinal system: Basic knowledge for the pediatric cardiologist. In The Science and Practice of Pediatric Cardiology; Lea & Febiger: Philadelphia, PA, USA, 1990; pp. 2354–2370. [Google Scholar]
- Schuurmans, F.M.; Pulles-Heintzberger, C.F.M.; Gerver, W.J.M.; Kester, A.D.M.; Forget, P.P. Long-term growth of children with congenital heart disease: A retrospective study. Acta Paediatr. 1998, 87, 1250–1255. [Google Scholar] [CrossRef]
- Leitch, C.A. Growth, nutrition and energy expenditure in pediatric heart failure. Prog. Pediatr. Cardiol. 2000, 11, 195–202. [Google Scholar] [CrossRef]
- Varan, B.; Tokel, K.; Yilmaz, G. Malnutrition and growth failure in cyanotic and acyanotic congenital heart disease with and without pulmonary hypertension. Arch. Dis. Child. 1999, 81, 49–52. [Google Scholar] [CrossRef]
- Menon, G.; Poskitt, E.M. Why does congenital heart disease cause failure to thrive? Arch. Dis. Child. 1985, 60, 1134–1139. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Baaker, R.H.; Abass, A.A.; Kamel, A.A. Malnutrition and growth status in patients with congenital heart disease. Iraqi Postgrad Med. J. 2008, 7, 152–156. [Google Scholar]
- World Health Organization. The use and interpretation of anthropometry: Report of a WHO expert committee. World Health Organ. Tech. Rep. Ser. 1995, 854, 312–409. [Google Scholar]
- Arodiwe, I.; Chinawa, J.; Ujunwa, F.; Adiele, D.; Ukoha, M.; Obidike, E. Nutritional status of congenital heart disease (CHD) patients: Burden and determinant of malnutrition at university of Nigeria teaching hospital Ituku–Ozalla, Enugu. Pak. J. Med. Sci. 2015, 31, 1140–1145. [Google Scholar] [CrossRef]
Variables | Cases (n = 64) | Comparisons (n = 630) | OR | 95% CI | p-Value |
---|---|---|---|---|---|
Severe sepsis Bacteremia | 8 (13) 4 (6) | 33 (5) 12 (2) | 2.58 3.43 | 1.14–5.87 1.07–10.98 | 0.027 0.050 |
Heart failure | 11 (17) | 24 (4) | 5.24 | 2.43–11.28 | <0.001 |
Respiratory failure | 5 (8) | 17 (3) | 3.06 | 1.09–8.58 | 0.044 |
Death | 7 (11) | 19 (3) | 3.10 | 1.56–6.12 | 0.001 |
Variables | OR | 95% CI | p-Value |
---|---|---|---|
Diarrhea | 1.36 | 0.66–2.82 | 0.400 |
Cough | 4.53 | 1.09–18.92 | 0.038 |
Respiratory distress | 2.80 | 1.46–5.39 | 0.002 |
Cyanosis | 6.70 | 0.63–71.08 | 0.110 |
Hypoglycemia | 2.49 | 0.75–8.29 | 0.136 |
Hypoxemia | 3.30 | 1.59–6.86 | 0.001 |
Hypernatremia | 0.68 | 0.27–1.68 | 0.401 |
Hyponatremia | 0.30 | 0.08–1.03 | 0.056 |
Hyperkalemia | 1.58 | 0.78–3.19 | 0.205 |
Radial pulse | 0.99 | 0.97–1.02 | 0.580 |
Respiratory rate | 1.01 | 0.97–1.05 | 0.740 |
Duration of hospitalization | 1.02 | 0.97–1.07 | 0.406 |
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Shahid, A.S.M.S.B.; Alam, T.; Ackhter, M.M.; Islam, M.Z.; Parvin, I.; Shaima, S.N.; Shahrin, L.; Ahmed, T.; Chowdhury, F.; Chisti, M.J. Factors Associated with Congenital Heart Disease in Severely Malnourished Children under Five and Their Outcomes at an Urban Hospital, Bangladesh. Children 2022, 9, 1. https://doi.org/10.3390/children9010001
Shahid ASMSB, Alam T, Ackhter MM, Islam MZ, Parvin I, Shaima SN, Shahrin L, Ahmed T, Chowdhury F, Chisti MJ. Factors Associated with Congenital Heart Disease in Severely Malnourished Children under Five and Their Outcomes at an Urban Hospital, Bangladesh. Children. 2022; 9(1):1. https://doi.org/10.3390/children9010001
Chicago/Turabian StyleShahid, Abu Sadat Mohammad Sayeem Bin, Tahmina Alam, Mst. Mahmuda Ackhter, Md. Zahidul Islam, Irin Parvin, Shamsun Nahar Shaima, Lubaba Shahrin, Tahmeed Ahmed, Fahmida Chowdhury, and Mohammod Jobayer Chisti. 2022. "Factors Associated with Congenital Heart Disease in Severely Malnourished Children under Five and Their Outcomes at an Urban Hospital, Bangladesh" Children 9, no. 1: 1. https://doi.org/10.3390/children9010001