247: A NOVEL REAL-TIME PATIENT MONITORING SYSTEM FOR DETECTION OF ARRHYTHMIAS IN CONGENITAL HEART DISEASE

Abstract

Learning Objectives: Children with congenital heart disease (CHD) are at increased risk of malnutrition. Studies have shown that congenital heart surgery (CHS) with or without cardiopulmonary bypass (CPB) is poorly tolerated in malnourished patients. The aim of this study was to determine the association between malnutrition and clinical outcomes after CHS. Methods: IRB approved retrospective cohort study of children admitted to the cardiac intensive care unit (CICU) after CHS from 1/2012 to 12/2014. Nutritional status assessed by World Health Organization and Center for Disease Control criteria to determine whether children were underweight (weight for age Z score, WAZ), had stunting (height for age Z score, HAZ) or had wasting (weight for height Z score, WFHZ). Malnutrition defined as mild and moderate-severe if Z score was < -1 and < -2, respectively. Surgical risk was determine using RACHS-1 method (Risk Adjusted for Congenital Heart Surgery). Primary outcome was mortality and secondary outcomes included CPB time, duration of mechanical ventilation, CICU and hospital length of stays (LOS). Data is expressed as median and IQR and analysis performed using Mann-Whitney and logistic regression. Results: A total of 1204 children (56% male) with a median age 1.04 yr (IQR 25th-75th 0.2–5.7) were included. The prevalence of underweight patients was 37.8%. Children found to be underweight were younger than those without malnutrition (0.51 vs. 2.4 yrs, p<0.0001). Underweight status was associated with longer median mechanical ventilation time (27.4 vs 16.5 hours, p <0.0001), longer CICU LOS (4 vs. 3 days, p<0.0001), and longer hospital LOS (9 vs. 7 days, p<0.0001). RACHS-1 categories 14 compared to categories 5–6 were more commonly associated with underweight status; odds ratio (OR) (95% C.I.) 3.08 (1.47–6.45) (p=0.0029) and 2.69 (1.28–5.65) (p=0.0088), respectively. Overall mortality in this cohort was 1.99% (24/1204) and was not associated with underweight OR 1.18 (0.52–2.67) (p=0.6991). Conclusions: Underweight is a common finding among children undergoing surgical correction for CHD. There was an association between poor nutritional status, increased ICU and hospital length of stay and duration of mechanical ventilation after cardiac surgery. No association was found between malnutrition and mortality. Further analysis of this cohort is needed to identify additional factors associated with malnutrition in the postoperative stage. CCMCritical Care MedicineCrit Care Med0090-3493Lippincott Williams & WilkinsHagerstown, MD CCM