Growth Asymmetry, Head Circumference, and Neurodevelopmental Outcomes in Infants with Single Ventricles

Abstract

Objective: To assess the variability in asymmetric growth and its association with neurodevelopment in infants with single ventricle (SV).

Study design: We analyzed weight-for-age z-score minus head circumference-for-age z-score (HCAZ), relative head growth (cm/kg), along with individual growth variables in subjects prospectively enrolled in the Infant Single Ventricle Trial. Associations between growth indices and scores on the Psychomotor Developmental Index (PDI) and Mental Developmental Index (MDI) of the Bayley Scales of Infant Development-II (BSID-II) at 14 months were assessed.

Results: Of the 230 subjects enrolled in the Infant Single Ventricle trial, complete growth data and BSID-II scores were available in 168 (73%). Across the cohort, indices of asymmetric growth varied widely at enrollment and before superior cavopulmonary connection (SCPC) surgery. BSID-II scores were not associated with these asymmetry indices. In bivariate analyses, greater pre-SCPC HCAZ correlated with higher MDI (r = 0.21; P = .006) and PDI (r = 0.38; P < .001) and a greater HCAZ increase from enrollment to pre-SCPC with higher PDI (r = 0.15; P = .049). In multivariable modeling, pre-SCPC HCAZ was an independent predictor of PDI (P = .03), but not MDI.

Conclusion: In infants with SV, growth asymmetry was not associated with neurodevelopment at 14 months, but pre-SCPC HCAZ was associated with PDI. Asymmetric growth, important in other high-risk infants, is not a brain-sparing adaptation in infants with SV.

Trial registration: Clinicaltrials.gov: NCT00113087.

Conflict of interest statement

The authors declare no conflicts of interest.

Copyright © 2016 Elsevier Inc. All rights reserved.

Figures

Figure 1

Summary of Individual Anthropometric Distribution. Box and whisker plots display the median, 25–75th percentile, minimum and maximum for the study cohort at the two time points. WAZ=weight for age z-score, LAZ=length for age z-score, HCAZ=head circumference for age z-score, SCPC=superior cavopulmonary connection. * p<0.001 for same measure at pre-SCPC compared to enrollment.

Figure 2

Summary of Individual Anthropometric Asymmetry Distribution. Box and whisker plots display the median, 25–75th percentile, minimum and maximum for the study cohort at the two time points. WLZ=weight for length z-score, WAZ-HCAZ = weight for age z-score minus head circumference for age z-score, SCPC=superior cavopulmonary connection, Rel HG= relative head growth. * p<0.001 for same measure at pre-SCPC compared to enrollment.