Elsevier

The Journal of Pediatrics

Volume 159, Issue 6, December 2011, Pages 1017-1022.e2
The Journal of Pediatrics

Original Article
Factors Affecting Growth in Infants with Single Ventricle Physiology: A Report from the Pediatric Heart Network Infant Single Ventricle Trial

https://doi.org/10.1016/j.jpeds.2011.05.051Get rights and content

Objectives

To describe growth patterns in infants with single ventricle physiology and determine factors influencing growth.

Study design

Data from 230 subjects enrolled in the Pediatric Heart Network Infant Single Ventricle Enalapril Trial were used to assess factors influencing change in weight-for-age z-score (∆z) from study enrollment (0.7 ± 0.4 months) to pre-superior cavopulmonary connection (SCPC; 5.1 ± 1.8 months, period 1) and pre-SCPC to final study visit (14.1 ± 0.9 months, period 2). Predictor variables included patient characteristics, feeding regimen, clinical center, and medical factors during neonatal (period 1) and SCPC hospitalizations (period 2). Univariate regression analysis was performed, followed by backward stepwise regression and bootstrapping reliability to inform a final multivariable model.

Results

Weights were available for 197 of 230 subjects for period 1 and 173 of 197 subjects for period 2. For period 1, greater gestational age, younger age at study enrollment, tube feeding at neonatal hospitalization discharge, and clinical center were associated with a greater negative ∆z (poorer growth) in multivariable modeling (adjusted R2 = 0.39, P < .001). For period 2, younger age at SCPC and greater daily caloric intake were associated with greater positive ∆z (better growth; R2 = 0.10, P = .002).

Conclusions

Aggressive nutritional support and earlier SCPC are modifiable factors associated with a favorable change in weight-for-age z-score.

Section snippets

Methods

Details of the ISV Trial study design and main results have been published.10, 11 In brief, ISV physiology between 1 week and 45 days of age with stable systemic and pulmonary blood flow in whom an SCPC (bidirectional Glenn anastamosis, bilateral bidirectional Glenn anastamosis, or hemi-Fontan procedure) was planned were enrolled. Exclusion criteria included gestational age <35 weeks, small for gestational age (<10th percentile), a recognizable chromosomal or phenotypic syndromes associated

Results

The clinical characteristics of the 230 subjects enrolled in the ISV Trial are shown in Table I (available at www.jpeds.com). Mean age at trial enrollment was 20.4 ± 9.0 days, and 63% of subjects had a diagnosis of hypoplastic left heart syndrome. Of the 230 subjects, 28 were withdrawn from the study before the pre-SCPC visit, and two did not have a pre-SCPC visit. Reasons for withdrawal included death in 15 subjects, transplant in two subjects, family choice in 8 subjects, physician choice in

Discussion

Growth failure is common in infants with congenital heart disease, including those with single ventricle physiology.5, 6, 8, 9, 13 There are likely multiple mechanisms contributing to growth failure in this population, including chronic cyanosis, alterations in energy expenditure,14, 15 inadequate caloric intake,16, 17 genetic factors,18 and alterations in serum growth factors and growth hormone.19 It can be difficult to achieve adequate nutrition in neonates with single ventricle physiology

References (21)

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Cited by (0)

Supported by the National Heart, Lung, and Blood Institute (U01 grants HL068269, HL068270, HL068279, HL068281, HL068285, HL068292, HL068290, HL068288, HL085057) and the US Food and Drug Administration Office of Orphan Products Development. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of National Heart, Lung, and Blood Institute or National Institutes of Health. The authors declare no conflicts of interest.

Trial is registered at www.clinicaltrials.gov (NCT00113087).

List of investigators of the Pediatric Heart Network is available at www.jpeds.com (Appendix).

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