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, Pediatric Heart Network Investigators, Gail Pearson, Victoria Pemberton, Mario Stylianou, Marsha Mathis, Lynn Mahony, Lynn Sleeper, Steven Colan, Lisa Virzi, Lisa Wruck, Victor Zak, David F Teitel, Jane W Newburger, Roger Breitbart, Jami Levine, Ellen McGrath, Carolyn Dunbar-Masterson, Daphne Hsu, William Hellenbrand, Ashwin Prakash, Seema Mital, Darlene Servedio, Victoria L Vetter, Chitra Ravishankar, Sarah Tabbutt, Meryl Cohen, Katherine Lee, Marisa Nolan, Stephanie Piacentino, Michelle Toms, D Woodrow Benson, Catherine Dent Krawczeski, Lois Bogenschutz, Teresa Barnard, Steven Schwartz, David Nelson, Page A W Anderson, Jennifer Li, Wesley Covitz, Kari Crawford, Michael Hines, James Jaggers, Theodore Koutlas, Charlie Sang Jr, Lori Jo Sutton, Mingfen Xu, J Philip Saul, Andrew Atz, Girish Shirali, Eric M Graham, Teresa Atz, L LuAnn Minich, John A Hawkins, Richard V Williams, Linda M Lambert, Marian E Shearrow, Brian McCrindle, Elizabeth Radojewski, Nancy Slater, Svetlana Khaikin, Susan McIntyre, Nancy Ghanayem, Kathy Mussatto, Michele Frommelt, Lisa Young-Borkowski, Albert Rocchini, Laurie Rodgers-Augustyniak, Steven Colan, Renee Margossian, Wendy Chung, Liyong Deng, Patricia Lanzano, Michael Artman, Judith Massicot-Fisher, Timothy Feltes, Julie Johnson, Thomas Klitzner, Jeffrey Krischer, G Paul Matherne, John Kugler, Rae-Ellen Kavey, David J Driscoll, Mark Galantowicz, Sally A Hunsberger, Thomas J Knight, Holly Taylor, Catherine L Webb, 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, Pediatric Heart Network Investigators, Gail Pearson, Victoria Pemberton, Mario Stylianou, Marsha Mathis, Lynn Mahony, Lynn Sleeper, Steven Colan, Lisa Virzi, Lisa Wruck, Victor Zak, David F Teitel, Jane W Newburger, Roger Breitbart, Jami Levine, Ellen McGrath, Carolyn Dunbar-Masterson, Daphne Hsu, William Hellenbrand, Ashwin Prakash, Seema Mital, Darlene Servedio, Victoria L Vetter, Chitra Ravishankar, Sarah Tabbutt, Meryl Cohen, Katherine Lee, Marisa Nolan, Stephanie Piacentino, Michelle Toms, D Woodrow Benson, Catherine Dent Krawczeski, Lois Bogenschutz, Teresa Barnard, Steven Schwartz, David Nelson, Page A W Anderson, Jennifer Li, Wesley Covitz, Kari Crawford, Michael Hines, James Jaggers, Theodore Koutlas, Charlie Sang Jr, Lori Jo Sutton, Mingfen Xu, J Philip Saul, Andrew Atz, Girish Shirali, Eric M Graham, Teresa Atz, L LuAnn Minich, John A Hawkins, Richard V Williams, Linda M Lambert, Marian E Shearrow, Brian McCrindle, Elizabeth Radojewski, Nancy Slater, Svetlana Khaikin, Susan McIntyre, Nancy Ghanayem, Kathy Mussatto, Michele Frommelt, Lisa Young-Borkowski, Albert Rocchini, Laurie Rodgers-Augustyniak, Steven Colan, Renee Margossian, Wendy Chung, Liyong Deng, Patricia Lanzano, Michael Artman, Judith Massicot-Fisher, Timothy Feltes, Julie Johnson, Thomas Klitzner, Jeffrey Krischer, G Paul Matherne, John Kugler, Rae-Ellen Kavey, David J Driscoll, Mark Galantowicz, Sally A Hunsberger, Thomas J Knight, Holly Taylor, Catherine L Webb
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.
Trial registration: ClinicalTrials.gov NCT00113087.
Conflict of interest statement
The authors declare no conflicts of interest. Registered at www.clinicaltrials.gov: NCT00113087
Copyright © 2013 Mosby, Inc. All rights reserved.
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Source: PubMed