Previous studies have investigated the eVect
of cardiac lesion type on growth and nutrition,
and several have reported that degree of
cyanosis is not correlated to severity of growth
impairment.1 6 However, degree of growth
impairment was found to be closely associated
with severity of the haemodynamic
impairment.1 11 12 Linde and colleagues6 found
a more pronounced retardation in both height
and weight in children with cyanosis than in
those with acyanotic heart disease, but did not
mention the eVect of pulmonary hypertension.
In contradiction to the report by Linde et al,
Salzer and colleagues5 showed that infants with
left to right shunt tended to gain less weight
and to be leaner than those with cyanotic heart
disease. In our study most of the cyanotic
patients without pulmonary hypertension were
of normal weight for their length or were mildly
malnourished (88%). However, 48% were
stunted and 40% failed to thrive. Thus, stunting
appears to be more common than wasting
in cyanotic heart disease without pulmonary
hypertension. We also investigated the impact
of pulmonary hypertension on growth and
nutrition in cyanotic heart disease, and found
that cyanotic patients with pulmonary hypertension
were the most severely aVected group,
81% having malnutrition, 56% having moderate
to severe malnutrition, and 56% failing to
thrive. Nutrition history gave the impression
that these patients consumed less nutrients
than the others. Most group cP patients had
compensated metabolic acidosis caused by
hypoxia, and all had pulmonary hypertension.
Both of these conditions can contribute to respiratory
diYculty and tachypnoea, and thus
limit nutrient intake. In addition, chronic
hypoxia, as discussed previously, is an important
factor in anorexia and ineYcient processing
of nutrients at the cellular level.