Abstract 17197: Prevalence and Severity of Malnutrition in Children With End-Stage Heart Failure Evaluated for Heart Transplantation
Background: Malnutrition is an important complication of end-stage heart failure (HF) in children. The prevalence and severity of malnutrition in pediatric advanced HF patients is unknown. We sought to determine the prevalence and severity of malnutrition in children referred for heart transplant (HT) evaluation using contemporary definitions.
Methods: All children referred for HT evaluation at Stanford from April 2015 to April 2016 were identified using a hospital database. Using criteria adapted from the American Society of Parenteral and Enteral Nutrition (ASPEN) guidelines, malnutrition was defined using the lowest z score for weight-for-age (WAZ), height-for-age (HAZ), and/or BMI-for-age (BAZ) at a time when the patient was believed to be euvolemic. Malnutrition was defined as mild for z scores of -1 to -1.99, moderate for z scores of -2 to -2.99, and severe for z scores of <-3.0.
Results: Overall, 45 children met the inclusion criteria. The median age was 8 years (IQR, 1, 13); 62% had CHD of which 86% had single ventricle lesions. Overall, the median WAZ was -1.9 (-3.0, -0.4); median HAZ was -1.5 (-2.6, -0.9), and BAZ -0.9 (-1.9, 0.9). Malnutrition was classified as not present in 22%, mild in 11%, moderate in 33%, and severe in 33%. Children with single ventricle lesions were twice as likely to have severe malnutrition compared to children with cardiomyopathy (P=0.028) and was a factor commonly cited in decisions to decline transplant (53%). Moderate to severe malnutrition was associated with a trend toward higher unadjusted mortality (P=0.056) compared to less malnutrition.
Conclusions: Severe malnutrition is common among children referred for heart transplant evaluation, especially children with single ventricle heart disease, and may be associated with high mortality. Encouraging earlier referral and finding efficient ways to nutritionally rehabilitate children with end-stage heart failure are warranted.
Author Disclosures: K.M. Dennis: None. K.A. Christenson: None. L.M. Schultz: None. A.K. Kipps: None. M. Snyder: None. J.C. Dykes: None. K. Maeda: None. B.D. Kaufman: None. S.A. Hollander: None. K. Jensen: None. S. Feehan: None. D.N. Rosenthal: None. C.S. Almond: None.
- © 2016 by American Heart Association, Inc.