Cardiac size reduced in malnourished children

Cardiothoracic ratios (CTR) are lower than the mean and R wave amplitudes are decreased in acutely malnourished children, reports a preliminary study presented at the 54th Annual Meeting of the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN 2022).

In addition, children with severe acute malnutrition (SAM) have more tachycardia, shorter PR interval, smaller left atrial and left ventricular end-systolic dimensions, and higher pulmonary artery pressure than those with moderate acute malnutrition (MAM). On the other hand, systolic and diastolic functions are within normal range in both cohorts.

“There is a consensus that cardiac size is reduced in proportion to body mass in malnourished children, but there have been conflicting findings in terms of cardiac functions,” said the researchers, led by Dr Roumilla Mendoza from the Department of Paediatrics at West Visayas State University Medical Center (WVSUMC), Iloilo City, Philippines.

“The dearth of local studies on the cardiac functions of this group of patients has resulted in anecdotal assumptions as to the sudden cause of death of children with acute malnutrition while undergoing fluid and nutritional therapy, thus prompting the need for this study,” they noted.

The researchers carried out this descriptive cross-sectional study from February 2019 to December 2020 at the WVSUMC following ethics approval. Children aged 6‒60 months with MAM and SAM, determined using the World Health Organization growth standards, at the emergency room/ward/outpatient department were considered for inclusion.

Malnourished patients who were critically ill were excluded, as well as infants delivered preterm or low birth weight, those diagnosed by history and/or laboratory congenital heart disease, with haemoglobin levels ≤6 g/dl, on medications that can affect cardiac function, diagnosed by history and/or laboratory to have metabolic problems, and with severe skeletal deformity that will affect accurate measurement of the weight, length/height, or midupper arm circumference as determined by the researchers.

Of the 22 patients who met the eligibility criteria, 14 had MAM and eight had SAM. Majority of the children in both groups were 13‒36 months of age. [ESPGHAN 2022, abstract N-P-089]

Images from chest x-ray exhibited CTR within the normal range, but children with MAM and those with SAM aged 37‒60 months showed CTR below 0.50. In electrocardiogram studies, both groups showed low R wave amplitude, whereas the SAM group had shortened PR interval. Additionally, children with SAM were more likely to have sinus tachycardia than those with MAM (50 percent vs 21 percent).

Both groups had normal 2D-echocardiogram measurements of chamber and wall dimensions based on age and body surface area, but the SAM group had lower left atrial dimensions (p=0.006) and left ventricular end-systolic dimensions (p=0.037) than the MAM group. Likewise, children with SAM had higher pulmonary artery pressure than those with MAM (p=0.026).

Finally, systolic and diastolic functions were preserved in both cohorts.

“Acutely malnourished children have CTRs lower than the mean and with lower R wave amplitudes,” the researchers said. “Those with SAM have more tachycardia, shorter PR interval, smaller left atrial and left ventricular end-systolic dimensions, and higher pulmonary artery pressure than children with MAM.