Factors affecting growth in infants with single ventricle physiology: a report from the Pediatric Heart Network Infant Single Ventricle Trial

Richard V Williams, Victor Zak, Chitra Ravishankar, Karen Altmann, Jeffrey Anderson, Andrew M Atz, Carolyn Dunbar-Masterson, Nancy Ghanayem, Linda Lambert, Karen Lurito, Barbara Medoff-Cooper, Renee Margossian, Victoria L Pemberton, Jennifer Russell, Mario Stylianou, Daphne 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 Newburger, Roger Breitbart, Jami Levine, Ellen McGrath, Carolyn Dunbar-Masterson, Daphne Hsu, William Hellenbrand, Ashwin Prakash, Darlene Servedio, Victoria L Vetter, Sarah Tabbutt, Katherine Lee, Marisa Nolan, Stephanie Piacentino, D Woodrow Benson, Catherine Dent, Lois Bogenschutz, Teresa Barnard, Steven Schwartz, David Nelson, Page A W Anderson, Wesley Covitz, Kari Crawford, Michael Hines, James Jaggers, Theodore Koutlas, Jennifer Li, Charlie Sang Jr, Lori Jo Sutton, Mingfen Xu, J Philip Saul, Andrew Atz, Girish Shirali, Teresa Atz, LuAnn Minich, Richard Williams, Linda Lambert, John Hawkins, Marian Sharrow, 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, Richard V Williams, Victor Zak, Chitra Ravishankar, Karen Altmann, Jeffrey Anderson, Andrew M Atz, Carolyn Dunbar-Masterson, Nancy Ghanayem, Linda Lambert, Karen Lurito, Barbara Medoff-Cooper, Renee Margossian, Victoria L Pemberton, Jennifer Russell, Mario Stylianou, Daphne 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 Newburger, Roger Breitbart, Jami Levine, Ellen McGrath, Carolyn Dunbar-Masterson, Daphne Hsu, William Hellenbrand, Ashwin Prakash, Darlene Servedio, Victoria L Vetter, Sarah Tabbutt, Katherine Lee, Marisa Nolan, Stephanie Piacentino, D Woodrow Benson, Catherine Dent, Lois Bogenschutz, Teresa Barnard, Steven Schwartz, David Nelson, Page A W Anderson, Wesley Covitz, Kari Crawford, Michael Hines, James Jaggers, Theodore Koutlas, Jennifer Li, Charlie Sang Jr, Lori Jo Sutton, Mingfen Xu, J Philip Saul, Andrew Atz, Girish Shirali, Teresa Atz, LuAnn Minich, Richard Williams, Linda Lambert, John Hawkins, Marian Sharrow, 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 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 R(2) = 0.39, P < .001). For period 2, younger age at SCPC and greater daily caloric intake were associated with greater positive z (better growth; R(2) = 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.

Trial registration: ClinicalTrials.gov NCT00113087.

Conflict of interest statement

The authors declare no conflicts of interest.

Copyright © 2011 Mosby, Inc. All rights reserved.

Figures

Figure 1
Figure 1
A. Lowess-smoothed curve and scatter plot of weight-for-age z-score vs. age in months. B. Lowess-smoothed curve and scatter plot of height-for-age z-score vs. age in months.
Figure 1
Figure 1
A. Lowess-smoothed curve and scatter plot of weight-for-age z-score vs. age in months. B. Lowess-smoothed curve and scatter plot of height-for-age z-score vs. age in months.
Figure 2
Figure 2
Box plots of weight- and height-for-age z-scores at baseline (median age 0.6 months, n=229), pre-SCPC (median age 4.8 months, n=197), and at 14 months (median age 14.0 months, n=185). The lower, middle, and upper edges of the box represent the 25th, 50th, and 75th percentiles, respectively. The “+” symbol represents the mean. SCPC – superior cavopulmonary connection.

Source: PubMed

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