Longitudinal assessment of growth in hypoplastic left heart syndrome: Results from the Single Ventricle Reconstruction Trial

Pediatric Heart Network Investigators

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background-We sought to characterize growth between birth and age 3 years in infants with hypoplastic left heart syndrome who underwent the Norwood procedure. Methods and Results-We performed a secondary analysis using the Single Ventricle Reconstruction Trial database after excluding patients < 37 weeks gestation (N=498). We determined length-for-age z score (LAZ) and weight-for-age z score (WAZ) at birth and age 3 years and change in WAZ over 4 clinically relevant time periods. We identified correlates of change in WAZ and LAZ using multivariable linear regression with bootstrapping. Mean WAZ and LAZ were below average relative to the general population at birth (P < 0.001, P=0.05, respectively) and age 3 years (P < 0.001 each). The largest decrease in WAZ occurred between birth and Norwood discharge; the greatest gain occurred between stage II and 14 months. At age 3 years, WAZ and LAZ were < -2 in 6% and 18%, respectively. Factors associated with change in WAZ differed among time periods. Shunt type was associated with change in WAZ only in the Norwood discharge to stage II period; subjects with a Blalock-Taussig shunt had a greater decline in WAZ than those with a right ventricle-pulmonary artery shunt (P=0.002). Conclusions-WAZ changed over time and the predictors of change in WAZ varied among time periods. By age 3 years, subjects remained small and three times as many children were short as were underweight (> 2 SD below normal). Failure to find consistent risk factors supports the strategy of tailoring nutritional therapies to patient- and stage-specific targets.

Original languageEnglish (US)
Article number000079
JournalJournal of the American Heart Association
Volume3
Issue number3
DOIs
StatePublished - Jan 1 2014

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Hypoplastic Left Heart Syndrome
Norwood Procedures
Growth
Parturition
Databases
Therapeutics

Keywords

  • Growth
  • Hypoplastic left heart syndrome
  • Pediatrics
  • Risk factors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Longitudinal assessment of growth in hypoplastic left heart syndrome : Results from the Single Ventricle Reconstruction Trial. / Pediatric Heart Network Investigators.

In: Journal of the American Heart Association, Vol. 3, No. 3, 000079, 01.01.2014.

Research output: Contribution to journalArticle

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abstract = "Background-We sought to characterize growth between birth and age 3 years in infants with hypoplastic left heart syndrome who underwent the Norwood procedure. Methods and Results-We performed a secondary analysis using the Single Ventricle Reconstruction Trial database after excluding patients < 37 weeks gestation (N=498). We determined length-for-age z score (LAZ) and weight-for-age z score (WAZ) at birth and age 3 years and change in WAZ over 4 clinically relevant time periods. We identified correlates of change in WAZ and LAZ using multivariable linear regression with bootstrapping. Mean WAZ and LAZ were below average relative to the general population at birth (P < 0.001, P=0.05, respectively) and age 3 years (P < 0.001 each). The largest decrease in WAZ occurred between birth and Norwood discharge; the greatest gain occurred between stage II and 14 months. At age 3 years, WAZ and LAZ were < -2 in 6{\%} and 18{\%}, respectively. Factors associated with change in WAZ differed among time periods. Shunt type was associated with change in WAZ only in the Norwood discharge to stage II period; subjects with a Blalock-Taussig shunt had a greater decline in WAZ than those with a right ventricle-pulmonary artery shunt (P=0.002). Conclusions-WAZ changed over time and the predictors of change in WAZ varied among time periods. By age 3 years, subjects remained small and three times as many children were short as were underweight (> 2 SD below normal). Failure to find consistent risk factors supports the strategy of tailoring nutritional therapies to patient- and stage-specific targets.",
keywords = "Growth, Hypoplastic left heart syndrome, Pediatrics, Risk factors",
author = "{Pediatric Heart Network Investigators} and Burch, {Phillip T.} and Eric Gerstenberger and Chitra Ravishankar and Hehir, {David A.} and Davies, {Ryan R} and Colan, {Steven D.} and Sleeper, {Lynn A.} and Newburger, {Jane W.} and Clabby, {Martha L.} and Williams, {Ismee A.} and Li, {Jennifer S.} and Karen Uzark and Cooper, {David S.} and Lambert, {Linda M.} and Pemberton, {Victoria L.} and Pike, {Nancy A.} and Anderson, {Jeffrey B.} and Carolyn Dunbar-Masterson and Svetlana Khaikin and Zyblewski, {Sinai C.} and Minich, {L. Lu Ann}",
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AU - Pediatric Heart Network Investigators

AU - Burch, Phillip T.

AU - Gerstenberger, Eric

AU - Ravishankar, Chitra

AU - Hehir, David A.

AU - Davies, Ryan R

AU - Colan, Steven D.

AU - Sleeper, Lynn A.

AU - Newburger, Jane W.

AU - Clabby, Martha L.

AU - Williams, Ismee A.

AU - Li, Jennifer S.

AU - Uzark, Karen

AU - Cooper, David S.

AU - Lambert, Linda M.

AU - Pemberton, Victoria L.

AU - Pike, Nancy A.

AU - Anderson, Jeffrey B.

AU - Dunbar-Masterson, Carolyn

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AU - Minich, L. Lu Ann

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N2 - Background-We sought to characterize growth between birth and age 3 years in infants with hypoplastic left heart syndrome who underwent the Norwood procedure. Methods and Results-We performed a secondary analysis using the Single Ventricle Reconstruction Trial database after excluding patients < 37 weeks gestation (N=498). We determined length-for-age z score (LAZ) and weight-for-age z score (WAZ) at birth and age 3 years and change in WAZ over 4 clinically relevant time periods. We identified correlates of change in WAZ and LAZ using multivariable linear regression with bootstrapping. Mean WAZ and LAZ were below average relative to the general population at birth (P < 0.001, P=0.05, respectively) and age 3 years (P < 0.001 each). The largest decrease in WAZ occurred between birth and Norwood discharge; the greatest gain occurred between stage II and 14 months. At age 3 years, WAZ and LAZ were < -2 in 6% and 18%, respectively. Factors associated with change in WAZ differed among time periods. Shunt type was associated with change in WAZ only in the Norwood discharge to stage II period; subjects with a Blalock-Taussig shunt had a greater decline in WAZ than those with a right ventricle-pulmonary artery shunt (P=0.002). Conclusions-WAZ changed over time and the predictors of change in WAZ varied among time periods. By age 3 years, subjects remained small and three times as many children were short as were underweight (> 2 SD below normal). Failure to find consistent risk factors supports the strategy of tailoring nutritional therapies to patient- and stage-specific targets.

AB - Background-We sought to characterize growth between birth and age 3 years in infants with hypoplastic left heart syndrome who underwent the Norwood procedure. Methods and Results-We performed a secondary analysis using the Single Ventricle Reconstruction Trial database after excluding patients < 37 weeks gestation (N=498). We determined length-for-age z score (LAZ) and weight-for-age z score (WAZ) at birth and age 3 years and change in WAZ over 4 clinically relevant time periods. We identified correlates of change in WAZ and LAZ using multivariable linear regression with bootstrapping. Mean WAZ and LAZ were below average relative to the general population at birth (P < 0.001, P=0.05, respectively) and age 3 years (P < 0.001 each). The largest decrease in WAZ occurred between birth and Norwood discharge; the greatest gain occurred between stage II and 14 months. At age 3 years, WAZ and LAZ were < -2 in 6% and 18%, respectively. Factors associated with change in WAZ differed among time periods. Shunt type was associated with change in WAZ only in the Norwood discharge to stage II period; subjects with a Blalock-Taussig shunt had a greater decline in WAZ than those with a right ventricle-pulmonary artery shunt (P=0.002). Conclusions-WAZ changed over time and the predictors of change in WAZ varied among time periods. By age 3 years, subjects remained small and three times as many children were short as were underweight (> 2 SD below normal). Failure to find consistent risk factors supports the strategy of tailoring nutritional therapies to patient- and stage-specific targets.

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