Impact of staged palliation on somatic growth in patients with hypoplastic left heart syndrome

Chandra Srinivasan, Robert D B Jaquiss, W. Robert Morrow, Elizabeth A. Frazier, DeeAnn Martin, Michiaki Imamura, Ritu Sachdeva

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background. Somatic growth pattern in infants undergoing staged palliation for hypoplastic left heart syndrome (Norwood procedure [NP], stage 2 palliation [S2P], and Fontan procedure [FP]) during transition toward a more energy efficient series circulation is not well understood.Objectives. We sought to determine growth pattern in these infants and factors influencing it.Methods. Patients who underwent NP since 2001 and survived at least 1 year after S2P were followed until FP or death/heart transplantation (n = 46). Weight for age z-scores (WAZ) were measured prior to NP; at initial discharge; prior to S2P; at four time periods after S2P; and prior to FP. Impact of gender, race, era of NP, anatomic subtype, NP shunt type, gastrostomy, home-surveillance program (daily weights and pulse oximetry), and interstage oxygen saturation on WAZ was evaluated.Results. Repeated measures anova showed a significant change in WAZ across time periods (P < 0.0005), with a significant decline from Pre-NP to Pre-S2P (P < 0.0005) and steady increase from Pre-S2P to Pre-FP (P= 0.016). None of the factors evaluated had a significant effect on this growth pattern. Length of hospital stay after NP was negatively correlated with WAZ at discharge (P= 0.001), but not for other time periods. Intervals from discharge to S2P and NP to S2P interval did not correlate with WAZ.Conclusion. Somatic growth is significantly impaired after NP but recovers steadily following S2P, as the patient transitions toward separated series circulation. Earlier S2P may lead to earlier resumption of normal growth in this critical period of early infancy.

Original languageEnglish (US)
Pages (from-to)546-551
Number of pages6
JournalCongenital Heart Disease
Volume5
Issue number6
DOIs
StatePublished - Nov 1 2010

Fingerprint

Norwood Procedures
Hypoplastic Left Heart Syndrome
Fontan Procedure
Weights and Measures
Growth
Length of Stay
Patient Transfer
Gastrostomy
Oximetry
Heart Transplantation
Oxygen

Keywords

  • Growth
  • Hypoplastic Left Heart Syndrome
  • Norwood Procedure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Radiology Nuclear Medicine and imaging

Cite this

Impact of staged palliation on somatic growth in patients with hypoplastic left heart syndrome. / Srinivasan, Chandra; Jaquiss, Robert D B; Morrow, W. Robert; Frazier, Elizabeth A.; Martin, DeeAnn; Imamura, Michiaki; Sachdeva, Ritu.

In: Congenital Heart Disease, Vol. 5, No. 6, 01.11.2010, p. 546-551.

Research output: Contribution to journalArticle

Srinivasan, Chandra ; Jaquiss, Robert D B ; Morrow, W. Robert ; Frazier, Elizabeth A. ; Martin, DeeAnn ; Imamura, Michiaki ; Sachdeva, Ritu. / Impact of staged palliation on somatic growth in patients with hypoplastic left heart syndrome. In: Congenital Heart Disease. 2010 ; Vol. 5, No. 6. pp. 546-551.
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abstract = "Background. Somatic growth pattern in infants undergoing staged palliation for hypoplastic left heart syndrome (Norwood procedure [NP], stage 2 palliation [S2P], and Fontan procedure [FP]) during transition toward a more energy efficient series circulation is not well understood.Objectives. We sought to determine growth pattern in these infants and factors influencing it.Methods. Patients who underwent NP since 2001 and survived at least 1 year after S2P were followed until FP or death/heart transplantation (n = 46). Weight for age z-scores (WAZ) were measured prior to NP; at initial discharge; prior to S2P; at four time periods after S2P; and prior to FP. Impact of gender, race, era of NP, anatomic subtype, NP shunt type, gastrostomy, home-surveillance program (daily weights and pulse oximetry), and interstage oxygen saturation on WAZ was evaluated.Results. Repeated measures anova showed a significant change in WAZ across time periods (P < 0.0005), with a significant decline from Pre-NP to Pre-S2P (P < 0.0005) and steady increase from Pre-S2P to Pre-FP (P= 0.016). None of the factors evaluated had a significant effect on this growth pattern. Length of hospital stay after NP was negatively correlated with WAZ at discharge (P= 0.001), but not for other time periods. Intervals from discharge to S2P and NP to S2P interval did not correlate with WAZ.Conclusion. Somatic growth is significantly impaired after NP but recovers steadily following S2P, as the patient transitions toward separated series circulation. Earlier S2P may lead to earlier resumption of normal growth in this critical period of early infancy.",
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AB - Background. Somatic growth pattern in infants undergoing staged palliation for hypoplastic left heart syndrome (Norwood procedure [NP], stage 2 palliation [S2P], and Fontan procedure [FP]) during transition toward a more energy efficient series circulation is not well understood.Objectives. We sought to determine growth pattern in these infants and factors influencing it.Methods. Patients who underwent NP since 2001 and survived at least 1 year after S2P were followed until FP or death/heart transplantation (n = 46). Weight for age z-scores (WAZ) were measured prior to NP; at initial discharge; prior to S2P; at four time periods after S2P; and prior to FP. Impact of gender, race, era of NP, anatomic subtype, NP shunt type, gastrostomy, home-surveillance program (daily weights and pulse oximetry), and interstage oxygen saturation on WAZ was evaluated.Results. Repeated measures anova showed a significant change in WAZ across time periods (P < 0.0005), with a significant decline from Pre-NP to Pre-S2P (P < 0.0005) and steady increase from Pre-S2P to Pre-FP (P= 0.016). None of the factors evaluated had a significant effect on this growth pattern. Length of hospital stay after NP was negatively correlated with WAZ at discharge (P= 0.001), but not for other time periods. Intervals from discharge to S2P and NP to S2P interval did not correlate with WAZ.Conclusion. Somatic growth is significantly impaired after NP but recovers steadily following S2P, as the patient transitions toward separated series circulation. Earlier S2P may lead to earlier resumption of normal growth in this critical period of early infancy.

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