Physical Development of Children Before and After Surgical Correction of Congenital Heart Disease and Factors Associated with Impaired Growth

Abstract

Objective. To assess the physical development of children from their first clinical presentation to surgery and during the 12 months following surgical correction of congenital heart disease (CHD), and to identify factors associated with changes in physical development.
Materials and Methods. A total of 128 children were examined, of whom 83 underwent surgery. Seventy-eight children had at least one postoperative anthropometric assessment. Weight, height, and body mass index were assessed using WHO z-scores at first clinical presentation, surgery (T0) and at 3, 6, 9, and 12 months thereafter. Preoperative changes, clinical categories, physical-development patterns, category transitions, and associated factors were also evaluated.
Results. From the first clinical presentation to surgery, WAZ decreased from −0.75 to −0.88 SD (p<0.001), and BAZ decreased from −0.03 to −0.13 SD (p=0.018), whereas HAZ did not change significantly (−1.19 and −1.23 SD; p=0.267). At 12 months after surgery, the adjusted changes were +0.259 SD for WAZ (95% CI 0.208–0.310; p<0.001), +0.337 SD for BAZ (95% CI 0.255–0.419; p<0.001), and +0.054 SD for HAZ (95% CI 0.005–0.102); the overall time effect for HAZ was not statistically significant (p=0.142). Underweight decreased from 9.1% to 2.6% (p=0.063), stunting remained present in 22.4%, and overweight/obesity increased from 4.0% to 14.7% (p=0.008). A longer waiting time to surgery was associated with smaller annual increases in WAZ (β=−0.097 SD/year; p=0.015) and BAZ (β=−0.144 SD/year; p=0.021).
Conclusion. During the first postoperative year, WAZ and BAZ improved substantially faster than HAZ, with the largest changes occurring during the second half of the year. Postoperative follow-up should include simultaneous monitoring of WAZ, HAZ, and BAZ and consideration of the time to surgical correction.