{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T15:09:35Z","timestamp":1788966575899,"version":"build-2803163510"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Malnutrition significantly affects children with congenital heart disease (CHD). Severe underweight status may prolong postoperative recovery and increase complications after cardiac surgery. Identifying modifiable risk factors may help improve outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods:<\/jats:title>\n                    <jats:p>\n                      Between January 2022 and December 2024, we included all children with a weight-for-age\n                      <jats:italic toggle=\"yes\">Z<\/jats:italic>\n                      score (WAZ) &lt;\u22123 who underwent palliative or corrective cardiac surgery (group 1). Demographic, laboratory, physiological, and clinical parameters were collected. Outcomes were compared with age- and risk-adjustment for congenital heart surgery-matched controls (group 2) with a normal WAZ (&gt;\u22122). The severely underweight group was subdivided into two subgroups, complicated (1a) and noncomplicated (1b), to analyze potential risk factors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 170 children were included; 86 were severely underweight. Means WAZ and weight-for-height\n                      <jats:italic toggle=\"yes\">Z<\/jats:italic>\n                      scores for group 1 were \u22124.4 \u00b1 0.16 and \u22123.75 \u00b1 0.43, respectively. The total complication rate was more in group (1), although it was not statistically different; cardiac and respiratory complications were higher in the severely underweight group. There were no differences in major cardiac events, unplanned interventions, or mortality. Severely underweight children had longer mechanical ventilation (MV), longer ICU and hospital stays, and more feeding difficulties.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Severe underweight significantly increases postoperative morbidity after congenital heart surgery. Factors that elevate oxidative stress in this fragile population may further amplify surgical risk. Large-scale studies are essential to better identify and understand the contributing risk factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/apc.apc_10_26","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:19:24Z","timestamp":1788949164000},"page":"497-502","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Severe underweight status predicts adverse postoperative outcomes after congenital heart surgery in children"],"prefix":"10.4103","volume":"19","author":[{"given":"Bana Nasser","family":"Agha","sequence":"first","affiliation":[{"name":"Department of Pediatric Cardiac Intensive Care, Prince Sultan Cardiac Center, Buraydah, Al-Qassim, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Usama Hagag","family":"Elsaedy","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiac Intensive Care, Prince Sultan Cardiac Center, Buraydah, Al-Qassim, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basel","family":"Harahsheh","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiac Surgery, Prince Sultan Cardiac Center, Buraydah, Al-Qassim, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwan","family":"Al Hobani","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiac Intensive Care, Prince Sultan Cardiac Center, Buraydah, Al-Qassim, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid","family":"Al Hawri","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiac Surgery, Prince Sultan Cardiac Center, Buraydah, Al-Qassim, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdu Rahman","family":"Al Mesned","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Prince Sultan Cardiac Center, Buraydah, Al-Qassim, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohmad Salim","family":"Kabbani","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiac Intensive Care, King Abdulaziz Medical City, King Saud Bin Abdulaziz University, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"R1-20260909","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1016\/j.aucc.2021.07.004","article-title":"Malnutrition on admission to the paediatric cardiac intensive care unit increases the risk of mortality and adverse outcomes following paediatric congenital heart surgery: A prospective cohort study","volume":"35","author":"Yilmaz Ferhatoglu","year":"2022","journal-title":"Aust Crit Care"},{"key":"R2-20260909","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1186\/s12887-023-04508-x","article-title":"Undernutrition in 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Defining death in a surgical registry database: A report of the STS congenital database taskforce and the joint EACTS-STS congenital database committee","volume":"81","author":"Jacobs","year":"2006","journal-title":"Ann Thorac Surg"},{"key":"R13-20260909","doi-asserted-by":"crossref","first-page":"1635","DOI":"10.1016\/j.athoracsur.2004.09.065","article-title":"Initial application in the STS congenital database of complexity adjustment to evaluate surgical case mix and results","volume":"79","author":"Jacobs","year":"2005","journal-title":"Ann Thorac Surg"},{"key":"R14-20260909","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1017\/S1047951125000484","article-title":"Achieving caloric goal in postoperative management of CHD surgery","volume":"35","author":"Tanyildiz","year":"2025","journal-title":"Cardiol Young"},{"key":"R15-20260909","doi-asserted-by":"crossref","first-page":"e267","DOI":"10.1016\/j.eclnm.2008.06.006","article-title":"Basics in clinical nutrition: Simple and stress starvation","volume":"3","author":"Barendregt","year":"2008","journal-title":"Eur E-J Clin Nutr Metab"},{"key":"R16-20260909","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1080\/10715762.2023.2284639","article-title":"Elevated oxidative stress in patients with congenital heart disease and the effect of cyanosis: A meta-analysis","volume":"57","author":"Vanreusel","year":"2023","journal-title":"Free Radic Res"},{"key":"R17-20260909","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1177\/0884533611399922","article-title":"Nutrition assessment as a predictor of clinical outcomes for infants with cardiac surgery: Using the prognostic nutritional index","volume":"26","author":"Wakita","year":"2011","journal-title":"Nutr Clin Pract"}],"container-title":["Annals of Pediatric Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/apc.apc_10_26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T14:14:42Z","timestamp":1788963282000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/apc.apc_10_26"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":15,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/apc.apc_10_26","relation":{},"ISSN":["0974-2069","0974-5149"],"issn-type":[{"value":"0974-2069","type":"print"},{"value":"0974-5149","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"2026-01-05","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-02","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}