Growth and IGF-1 changes in children with congenital heart disease: Evaluating the impact of cyanosis and surgical correction on somatic development

Background: Children with congenital heart disease (CHD) frequently exhibit growth retardation and endocrine abnormalities, particularly in the insulin-like growth factor 1 (IGF-1) axis. Cyanotic forms of CHD are associated with more severe deficits due to chronic hypoxia, undernutrition, and increased metabolic demands. While surgical correction improves hemodynamic status, its impact on growth and IGF-1 recovery across CHD subtypes requires comprehensive evaluation.

Objectives: To assess patterns of growth and IGF-1 suppression in children with cyanotic and acyanotic CHD, evaluate the effects of surgical intervention on somatic and endocrine recovery, and explore the role of nutritional support in optimizing outcomes.

Methods: This review synthesized data from two institutional datasets and 10 pivotal studies (1990–2024) involving over 4,000 children with CHD. Anthropometric measures (weight, height, BMI) and serum IGF-1 levels were analyzed before and after surgery. Children were stratified by CHD subtype (cyanotic vs. acyanotic). Additional literature was reviewed via PubMed and Scopus using search terms "congenital heart disease," "IGF-1," "growth," and "surgery." Inclusion criteria included studies on children <18 years with pre- and post-operative growth or IGF-1 data. Reference validation and statistical synthesis of correlations and prevalence rates were performed.

Results: Children with cyanotic CHD had significantly lower preoperative weight, height, and IGF-1 SDS compared to acyanotic patients. Postoperative follow-up (6–12 months) demonstrated significant improvements in all anthropometric indices and IGF-1 levels, especially in cyanotic subtypes. Recent studies (2012–2022) reported >80% recovery in growth and endocrine markers post-surgery. A strong positive correlation was observed between IGF-1 levels and weight/height SDS both pre- and post-operatively. Nutritional supplementation enhanced growth response, with malnutrition, older age, and pulmonary hypertension identified as predictors of poorer outcomes.

Conclusion: CHD in children, especially cyanotic types, results in marked growth failure and IGF^-1 suppression. Surgical correction leads to substantial somatic and hormonal recovery, particularly when performed early. IGF^-1 is a sensitive and reliable biomarker of growth normalization. Integration of surgical intervention with targeted nutritional support and endocrine surveillance is essential for optimal rehabilitation. Early identification of high-risk patients and personalized interventions may improve long-term growth and developmental trajectories.