Association of impaired linear growth and worse neurodevelopmental outcome in infants with single ventricle physiology

A report from the pediatric heart network infant single ventricle trial

Chitra Ravishankar, Victor Zak, Ismee A. Williams, David C. Bellinger, J. William Gaynor, Nancy S. Ghanayem, Catherine D. Krawczeski, Daniel J. Licht, Lynn Mahony, Jane W. Newburger, Victoria L. Pemberton, Richard V. Williams, Renee Sananes, Amanda L. Cook, Teresa Atz, Svetlana Khaikin, Daphne T. Hsu

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Objectives: To describe neurodevelopmental outcomes in infants with single ventricle (SV) physiology and determine factors associated with worse outcomes. Study design: Neurodevelopmental outcomes for infants with SV enrolled in a multicenter drug trial were assessed at 14 months of age using the Bayley Scales of Infant Development-II. Multivariable regression analysis was used to identify factors associated with worse outcomes. Results: Neurodevelopmental testing was performed at 14 ± 1 months in 170/185 subjects in the trial. Hypoplastic left heart syndrome was present in 59% and 75% had undergone the Norwood operation. Mean Psychomotor Developmental Index (PDI) and mental developmental index (MDI) were 80 ± 18 and 96 ± 14, respectively, (normal 100 ± 15, P < .001 for each). Group-based trajectory analysis provided a 2-group model ("high" and "low") for height z-score trajectory and brain type natriuretic peptide (BNP) trajectory. The predicted PDI scores were 15 points higher in the "high" height z-score trajectory compared with the "low" cluster (P < .001). A higher number of serious adverse events during the trial was associated with lower PDI scores (P = .02). The predicted MDI scores were 13-17 points lower in "low height trajectory-high BNP trajectory" group compared with the other 3 groups (P < .001). MDI scores were also lower in subjects who required extracorporeal membrane oxygenation during the neonatal hospitalization (P = .01) or supplemental oxygen at discharge (P = .01). Conclusions: Neurodevelopmental outcome at 14 months of age is impaired in infants with SV physiology. Low height trajectory and high BNP trajectory were associated with worse neurodevelopmental outcomes. Efforts to improve nutritional status alone may not improve neurodevelopmental outcomes.

Original languageEnglish (US)
JournalJournal of Pediatrics
Volume162
Issue number2
DOIs
StatePublished - Feb 2013

Fingerprint

Brain Natriuretic Peptide
Pediatrics
Growth
Norwood Procedures
Hypoplastic Left Heart Syndrome
Extracorporeal Membrane Oxygenation
Child Development
Nutritional Status
Multicenter Studies
Hospitalization
Regression Analysis
Oxygen
Pharmaceutical Preparations

Keywords

  • Atrioventricular
  • AV
  • Bayley Scale of Infant Development
  • BNP
  • Brain type natriuretic peptide
  • BSID
  • CHD
  • Congenital heart defects
  • ECMO
  • Extracorporeal membrane oxygenation
  • HLHS
  • Hypoplastic left heart syndrome
  • Infant single ventricle
  • ISV
  • Length of stay
  • LOS
  • MDI
  • Mental developmental index
  • PDI
  • Pediatric Heart Network
  • PHN
  • Psychomotor Developmental Index
  • SAE
  • SCPC
  • Serious adverse event
  • Single ventricle
  • Superior cavopulmonary connection
  • SV

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Association of impaired linear growth and worse neurodevelopmental outcome in infants with single ventricle physiology : A report from the pediatric heart network infant single ventricle trial. / Ravishankar, Chitra; Zak, Victor; Williams, Ismee A.; Bellinger, David C.; Gaynor, J. William; Ghanayem, Nancy S.; Krawczeski, Catherine D.; Licht, Daniel J.; Mahony, Lynn; Newburger, Jane W.; Pemberton, Victoria L.; Williams, Richard V.; Sananes, Renee; Cook, Amanda L.; Atz, Teresa; Khaikin, Svetlana; Hsu, Daphne T.

In: Journal of Pediatrics, Vol. 162, No. 2, 02.2013.

Research output: Contribution to journalArticle

Ravishankar, C, Zak, V, Williams, IA, Bellinger, DC, Gaynor, JW, Ghanayem, NS, Krawczeski, CD, Licht, DJ, Mahony, L, Newburger, JW, Pemberton, VL, Williams, RV, Sananes, R, Cook, AL, Atz, T, Khaikin, S & Hsu, DT 2013, 'Association of impaired linear growth and worse neurodevelopmental outcome in infants with single ventricle physiology: A report from the pediatric heart network infant single ventricle trial', Journal of Pediatrics, vol. 162, no. 2. https://doi.org/10.1016/j.jpeds.2012.07.048
Ravishankar, Chitra ; Zak, Victor ; Williams, Ismee A. ; Bellinger, David C. ; Gaynor, J. William ; Ghanayem, Nancy S. ; Krawczeski, Catherine D. ; Licht, Daniel J. ; Mahony, Lynn ; Newburger, Jane W. ; Pemberton, Victoria L. ; Williams, Richard V. ; Sananes, Renee ; Cook, Amanda L. ; Atz, Teresa ; Khaikin, Svetlana ; Hsu, Daphne T. / Association of impaired linear growth and worse neurodevelopmental outcome in infants with single ventricle physiology : A report from the pediatric heart network infant single ventricle trial. In: Journal of Pediatrics. 2013 ; Vol. 162, No. 2.
@article{0ac8a442696943878c96c299e1d6bd16,
title = "Association of impaired linear growth and worse neurodevelopmental outcome in infants with single ventricle physiology: A report from the pediatric heart network infant single ventricle trial",
abstract = "Objectives: To describe neurodevelopmental outcomes in infants with single ventricle (SV) physiology and determine factors associated with worse outcomes. Study design: Neurodevelopmental outcomes for infants with SV enrolled in a multicenter drug trial were assessed at 14 months of age using the Bayley Scales of Infant Development-II. Multivariable regression analysis was used to identify factors associated with worse outcomes. Results: Neurodevelopmental testing was performed at 14 ± 1 months in 170/185 subjects in the trial. Hypoplastic left heart syndrome was present in 59{\%} and 75{\%} had undergone the Norwood operation. Mean Psychomotor Developmental Index (PDI) and mental developmental index (MDI) were 80 ± 18 and 96 ± 14, respectively, (normal 100 ± 15, P < .001 for each). Group-based trajectory analysis provided a 2-group model ({"}high{"} and {"}low{"}) for height z-score trajectory and brain type natriuretic peptide (BNP) trajectory. The predicted PDI scores were 15 points higher in the {"}high{"} height z-score trajectory compared with the {"}low{"} cluster (P < .001). A higher number of serious adverse events during the trial was associated with lower PDI scores (P = .02). The predicted MDI scores were 13-17 points lower in {"}low height trajectory-high BNP trajectory{"} group compared with the other 3 groups (P < .001). MDI scores were also lower in subjects who required extracorporeal membrane oxygenation during the neonatal hospitalization (P = .01) or supplemental oxygen at discharge (P = .01). Conclusions: Neurodevelopmental outcome at 14 months of age is impaired in infants with SV physiology. Low height trajectory and high BNP trajectory were associated with worse neurodevelopmental outcomes. Efforts to improve nutritional status alone may not improve neurodevelopmental outcomes.",
keywords = "Atrioventricular, AV, Bayley Scale of Infant Development, BNP, Brain type natriuretic peptide, BSID, CHD, Congenital heart defects, ECMO, Extracorporeal membrane oxygenation, HLHS, Hypoplastic left heart syndrome, Infant single ventricle, ISV, Length of stay, LOS, MDI, Mental developmental index, PDI, Pediatric Heart Network, PHN, Psychomotor Developmental Index, SAE, SCPC, Serious adverse event, Single ventricle, Superior cavopulmonary connection, SV",
author = "Chitra Ravishankar and Victor Zak and Williams, {Ismee A.} and Bellinger, {David C.} and Gaynor, {J. William} and Ghanayem, {Nancy S.} and Krawczeski, {Catherine D.} and Licht, {Daniel J.} and Lynn Mahony and Newburger, {Jane W.} and Pemberton, {Victoria L.} and Williams, {Richard V.} and Renee Sananes and Cook, {Amanda L.} and Teresa Atz and Svetlana Khaikin and Hsu, {Daphne T.}",
year = "2013",
month = "2",
doi = "10.1016/j.jpeds.2012.07.048",
language = "English (US)",
volume = "162",
journal = "Journal of Pediatrics",
issn = "0022-3476",
publisher = "Mosby Inc.",
number = "2",

}

TY - JOUR

T1 - Association of impaired linear growth and worse neurodevelopmental outcome in infants with single ventricle physiology

T2 - A report from the pediatric heart network infant single ventricle trial

AU - Ravishankar, Chitra

AU - Zak, Victor

AU - Williams, Ismee A.

AU - Bellinger, David C.

AU - Gaynor, J. William

AU - Ghanayem, Nancy S.

AU - Krawczeski, Catherine D.

AU - Licht, Daniel J.

AU - Mahony, Lynn

AU - Newburger, Jane W.

AU - Pemberton, Victoria L.

AU - Williams, Richard V.

AU - Sananes, Renee

AU - Cook, Amanda L.

AU - Atz, Teresa

AU - Khaikin, Svetlana

AU - Hsu, Daphne T.

PY - 2013/2

Y1 - 2013/2

N2 - Objectives: To describe neurodevelopmental outcomes in infants with single ventricle (SV) physiology and determine factors associated with worse outcomes. Study design: Neurodevelopmental outcomes for infants with SV enrolled in a multicenter drug trial were assessed at 14 months of age using the Bayley Scales of Infant Development-II. Multivariable regression analysis was used to identify factors associated with worse outcomes. Results: Neurodevelopmental testing was performed at 14 ± 1 months in 170/185 subjects in the trial. Hypoplastic left heart syndrome was present in 59% and 75% had undergone the Norwood operation. Mean Psychomotor Developmental Index (PDI) and mental developmental index (MDI) were 80 ± 18 and 96 ± 14, respectively, (normal 100 ± 15, P < .001 for each). Group-based trajectory analysis provided a 2-group model ("high" and "low") for height z-score trajectory and brain type natriuretic peptide (BNP) trajectory. The predicted PDI scores were 15 points higher in the "high" height z-score trajectory compared with the "low" cluster (P < .001). A higher number of serious adverse events during the trial was associated with lower PDI scores (P = .02). The predicted MDI scores were 13-17 points lower in "low height trajectory-high BNP trajectory" group compared with the other 3 groups (P < .001). MDI scores were also lower in subjects who required extracorporeal membrane oxygenation during the neonatal hospitalization (P = .01) or supplemental oxygen at discharge (P = .01). Conclusions: Neurodevelopmental outcome at 14 months of age is impaired in infants with SV physiology. Low height trajectory and high BNP trajectory were associated with worse neurodevelopmental outcomes. Efforts to improve nutritional status alone may not improve neurodevelopmental outcomes.

AB - Objectives: To describe neurodevelopmental outcomes in infants with single ventricle (SV) physiology and determine factors associated with worse outcomes. Study design: Neurodevelopmental outcomes for infants with SV enrolled in a multicenter drug trial were assessed at 14 months of age using the Bayley Scales of Infant Development-II. Multivariable regression analysis was used to identify factors associated with worse outcomes. Results: Neurodevelopmental testing was performed at 14 ± 1 months in 170/185 subjects in the trial. Hypoplastic left heart syndrome was present in 59% and 75% had undergone the Norwood operation. Mean Psychomotor Developmental Index (PDI) and mental developmental index (MDI) were 80 ± 18 and 96 ± 14, respectively, (normal 100 ± 15, P < .001 for each). Group-based trajectory analysis provided a 2-group model ("high" and "low") for height z-score trajectory and brain type natriuretic peptide (BNP) trajectory. The predicted PDI scores were 15 points higher in the "high" height z-score trajectory compared with the "low" cluster (P < .001). A higher number of serious adverse events during the trial was associated with lower PDI scores (P = .02). The predicted MDI scores were 13-17 points lower in "low height trajectory-high BNP trajectory" group compared with the other 3 groups (P < .001). MDI scores were also lower in subjects who required extracorporeal membrane oxygenation during the neonatal hospitalization (P = .01) or supplemental oxygen at discharge (P = .01). Conclusions: Neurodevelopmental outcome at 14 months of age is impaired in infants with SV physiology. Low height trajectory and high BNP trajectory were associated with worse neurodevelopmental outcomes. Efforts to improve nutritional status alone may not improve neurodevelopmental outcomes.

KW - Atrioventricular

KW - AV

KW - Bayley Scale of Infant Development

KW - BNP

KW - Brain type natriuretic peptide

KW - BSID

KW - CHD

KW - Congenital heart defects

KW - ECMO

KW - Extracorporeal membrane oxygenation

KW - HLHS

KW - Hypoplastic left heart syndrome

KW - Infant single ventricle

KW - ISV

KW - Length of stay

KW - LOS

KW - MDI

KW - Mental developmental index

KW - PDI

KW - Pediatric Heart Network

KW - PHN

KW - Psychomotor Developmental Index

KW - SAE

KW - SCPC

KW - Serious adverse event

KW - Single ventricle

KW - Superior cavopulmonary connection

KW - SV

UR - http://www.scopus.com/inward/record.url?scp=84872309652&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84872309652&partnerID=8YFLogxK

U2 - 10.1016/j.jpeds.2012.07.048

DO - 10.1016/j.jpeds.2012.07.048

M3 - Article

VL - 162

JO - Journal of Pediatrics

JF - Journal of Pediatrics

SN - 0022-3476

IS - 2

ER -