Abstract 9298: Factors Impacting Growth in Infants with Single Ventricle Physiology in the First Year of Life: The Pediatric Heart Network Infant Single Ventricle Trial
Background: Growth failure is common in infants with single ventricle physiology (ISV). Factors influencing growth in the first year of life are not well understood.
Objectives: To describe growth patterns in ISV and determine factors associated with change in weight for age z score (Δz) during the first 14 months of life.
Methods: Serial growth measures were obtained in 230 patients enrolled in the Pediatric Heart Network ISV Trial. Subjects <35 weeks gestation, small for gestational age and with syndromes affecting growth were excluded. Factors influencing Δz were assessed for 2 time periods: 1) study enrollment (age 14±9 days) to superior cavopulmonary connection (SCPC) (age 5.5 ± 1.7 months), and 2) from SCPC to final study visit (age 14.1 ± 0.9 months). Predictor variables included patient characteristics, feeding regimen, and medical factors during neonatal and SCPC hospitalizations. Univariate regression analysis was performed for each variable, followed by backward stepwise regression and bootstrapping to inform a final multivariable model.
Results: As shown in the Table, weight and height for age z scores decreased before SCPC and increased afterwards. Head circumference for age z score increased during both periods. In the multivariable model for period 1, greater gestational age, younger enrollment age and tube feeding at neonatal discharge were associated with poorer growth (adjusted R2=0.30, p<0.001). For period 2, younger age at SCPC and greater daily caloric intake (kcal/kg) pre-SCPC were associated with improved growth (adjusted R2=0.08, p=0.002). Diagnosis, type of surgery, operative and post-operative factors at the time of neonatal palliation or SCPC were not significant predictors in multivariable modeling.
Conclusions: Volume unloading with SCPC is associated with improved growth in ISV. Interventions to optimize nutrition and timing of SCPC are modifiable factors that may influence growth in ISV during the first year of life.
- © 2010 by American Heart Association, Inc.