Variation in Growth of Infants with a Single Ventricle

• Published in: The Journal of pediatrics 2012-07, Vol.161 (1), p.16-21.e3
• Main Authors: Anderson, Jeffrey B., MD, MPH, Iyer, Srikant B., MD, MPH, Schidlow, David N., MD, Williams, Richard, MD, Varadarajan, Kartik, MPH, Horsley, Megan, LD, CSP, Slicker, Julie, RD, CSP, CD, CNSD, Pratt, Jesse, MS, King, Eileen, PhD, Lannon, Carole, MD
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Cardiology. Vascular system; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Feeding Behavior; General aspects; Growth; Heart; Heart Ventricles - abnormalities; Humans; Hypoplastic Left Heart Syndrome - physiopathology; Hypoplastic Left Heart Syndrome - surgery; Infant; infant growth; Infant, Newborn; infants; interviews; Male; Medical sciences; patients; Pediatrics; Retrospective Studies; weight gain
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2012.01.009

Objective The study goal was to evaluate interstage growth variation among sites participating in the National Pediatric Cardiology Quality Improvement Collaborative registry caring for infants with hypoplastic left heart syndrome and to identify nutritional practices common among sites achieving best growth outcomes. Study design This was a retrospective analysis of infants in the registry who had presented due to their superior cavopulmonary connection (SCPC) and whose surgical site had enrolled ≥4 eligible patients in the registry. The primary outcome variable was weight-for-age z-score (WAZ) change between Norwood discharge and presentation for SCPC (interstage period). Blinded, structured interviews were performed with each site regarding site-specific nutritional practices. Practices common among sites with positive interstage WAZ changes were identified. Results Sixteen centers enrolled 132 infants from December 2008 through December 2010. Median age at SCPC was 5 months (2.6-12.6), and median interstage WAZ change was −0.29 (−3.2 to 2.3). Significant variation in WAZ changes among sites was demonstrated ( P < .001). Sites that used standard feeding evaluation prior to Norwood discharge and that closely monitored for specific weight gain/loss red flags in the interstage period demonstrated significantly better patient growth than those that did not use these practices ( P = .002). Conclusions Considerable variation exists in interstage growth among patients receiving care at these 16 surgical sites. Standardization of interstage nutritional management with focus on best nutritional practices may lead to improved growth in this high-risk population of infants.