Crtical Care and Shock Journal

The effect of malnutrition on T3 levels in pediatric patients undergoing congenital heart surgery

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Objective: To define the effect of malnutrition and other factors such as age, the type of congenital heart defects and hemodynamics on T3 levels in pediatric patients with congenital heart anomalies before corrective surgery.

Design: prospective cross sectional study.

Setting: 13-bed Pediatric Cardiac Intensive Care Unit (PCICU) at the National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.

Patients and participants: Children between 0 and 2 years of age undergoing congenital heart surgery on cardiopulmonary bypass with an Aristotle score of 6 and above.

Interventions: No intervention.

Measurements: We prospectively enrolled over a 6-month period all patients less than 2 years of age undergoing congenital heart surgery. Baseline levels of TT3, FT3, TT4, FT4 and TSH were measured before surgery. The nutritional status was estimated from standard anthropometric measurements. The thyroid hormone levels were then correlated using unpaired T-test and Mann Whitney test.

Result: Out of 43 patients enrolled, 60.4% patients presented with moderate to severe malnutrition. Mean baseline FT3 levels were significantly reduced in severely malnourished patients compared to those in the well-nourished group (FT3: 4.9±0.7 vs. 3.5±0.3 pg/ml, p=0.04). There were no significant differrences of TT3, TT4, FT4 and TSH between groups. Sex, age, the presence of cyanosis and unrestrictive pulmonary blood flow before surgery did not show any significant differences of thyroid hormone levels between groups.

Conclusions: Severe malnutrition has a significant impact on FT3 levels in cardiac patients before surgery that make this group of patients probably more prone to an increased morbidity associated with a low T3 state (i.e. SES) after surgery.

Eva M. Marwali, Aria Kekalih, Nikolaus A. Haas


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