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LONGITUDINAL ASSESSMENT OF GROWTH 6 YEARS AFTER THE NORWOOD OPERATION: RESULTS FROM THE SINGLE VENTRICLE RECONSTRUCTION TRIAL
943 JACC April 5, 2016 Volume 67, Issue 13
Congenital Heart Disease LONGITUDINAL ASSESSMENT OF GROWTH 6 YEARS AFTER THE NORWOOD OPERATION: RESULTS FROM THE SINGLE VENTRICLE RECONSTRUCTION TRIAL Poster Contributions Poster Area, South Hall A1 Saturday, April 02, 2016, 10:00 a.m.-10:45 a.m. Session Title: New Developments in Single Ventricle Heart Disease Abstract Category: 23. Congenital Heart Disease: Pediatric Presentation Number: 1109-201 Authors: Phillip Todd Burch, Chitra Ravishankar, Jane Newburger, Linda Lambert, Victoria Pemberton, Suzanne Granger, Alejandro Floh, Jeffrey Anderson, Garick Hill, Kevin Hill, Matthew Oster, Ryan Davies, Jeffrey Jacobs, Wyman Lai, Alan Lewis, Kurt Schumacher, Sinai Zyblewski, L. LuAnn Minich, for the Pediatric Heart Network Investigators, Pediatric Heart Network, Bethesda, MD, USA Background: Growth faltering is common in children with hypoplastic left heart syndrome (HLHS) after the Norwood operation. We previously demonstrated that transplant-free survivors remained small at 3 years of age with mean weight-for-age z-scores (WAZ) and height-for-age z-scores (HAZ) below average. We sought to characterize somatic growth at age 6 years and to determine factors associated with impaired growth from birth to age 6 years.
Methods: We performed a secondary analysis of growth using the Single Ventricle Reconstruction Trial database obtained from 15 North American centers. Infants <37 weeks gestation were excluded. We used multivariable linear regression with bootstrapping to identify predictors of change in WAZ and HAZ from birth to age 6 years. Model covariates were selected from a subset of potential patient- and center-level predictors using a resampling procedure with reliability testing.
Results: Among 265 subjects at 6 years of age, the means (SDs) for WAZ and HAZ were below the normative mean (-0.58±1.13 and -1.03±1.18, respectively; each p<0.001). Compared to mean WAZ, mean HAZ was more impaired (p<0.001). At age 6 years, WAZ was <-1 in 37% and HAZ was <-1 in 51% (p<0.01) of subjects. WAZ was <-2 in 9% and HAZ <-2 in 18% (p<0.01) of subjects. Between birth and age 6 years, WAZ and HAZ dropped by >0.5 SD in 49% and 61% of subjects, respectively. Higher birth weight (p<0.001), longer cumulative length of stay (LOS) for all admissions (p=0.001) and white/non-Hispanic (compared to the reference of other/non-Hispanic, p=0.02) were independently associated with a greater drop in WAZ with and without center included in the model. Higher birth weight was the only factor independently associated with a greater drop in HAZ (p<0.001). Shunt type was not associated with WAZ or HAZ at 6 years of age. Conclusions: Children with HLHS remain short and underweight at 6 years of age with twice as many subjects being <-2 for HAZ compared to the proportion with WAZ <-2. Cumulative LOS (a surrogate for surgical and medical morbidity) was associated with poorer weight gain. In the current analysis, we did not identify any modifiable factors associated with growth at age 6 years.
Congenital Heart Disease LONGITUDINAL ASSESSMENT OF GROWTH 6 YEARS AFTER THE NORWOOD OPERATION: RESULTS FROM THE SINGLE VENTRICLE RECONSTRUCTION TRIAL Poster Contributions Poster Area, South Hall A1 Saturday, April 02, 2016, 10:00 a.m.-10:45 a.m. Session Title: New Developments in Single Ventricle Heart Disease Abstract Category: 23. Congenital Heart Disease: Pediatric Presentation Number: 1109-201 Authors: Phillip Todd Burch, Chitra Ravishankar, Jane Newburger, Linda Lambert, Victoria Pemberton, Suzanne Granger, Alejandro Floh, Jeffrey Anderson, Garick Hill, Kevin Hill, Matthew Oster, Ryan Davies, Jeffrey Jacobs, Wyman Lai, Alan Lewis, Kurt Schumacher, Sinai Zyblewski, L. LuAnn Minich, for the Pediatric Heart Network Investigators, Pediatric Heart Network, Bethesda, MD, USA Background: Growth faltering is common in children with hypoplastic left heart syndrome (HLHS) after the Norwood operation. We previously demonstrated that transplant-free survivors remained small at 3 years of age with mean weight-for-age z-scores (WAZ) and height-for-age z-scores (HAZ) below average. We sought to characterize somatic growth at age 6 years and to determine factors associated with impaired growth from birth to age 6 years.
Methods: We performed a secondary analysis of growth using the Single Ventricle Reconstruction Trial database obtained from 15 North American centers. Infants <37 weeks gestation were excluded. We used multivariable linear regression with bootstrapping to identify predictors of change in WAZ and HAZ from birth to age 6 years. Model covariates were selected from a subset of potential patient- and center-level predictors using a resampling procedure with reliability testing.
Results: Among 265 subjects at 6 years of age, the means (SDs) for WAZ and HAZ were below the normative mean (-0.58±1.13 and -1.03±1.18, respectively; each p<0.001). Compared to mean WAZ, mean HAZ was more impaired (p<0.001). At age 6 years, WAZ was <-1 in 37% and HAZ was <-1 in 51% (p<0.01) of subjects. WAZ was <-2 in 9% and HAZ <-2 in 18% (p<0.01) of subjects. Between birth and age 6 years, WAZ and HAZ dropped by >0.5 SD in 49% and 61% of subjects, respectively. Higher birth weight (p<0.001), longer cumulative length of stay (LOS) for all admissions (p=0.001) and white/non-Hispanic (compared to the reference of other/non-Hispanic, p=0.02) were independently associated with a greater drop in WAZ with and without center included in the model. Higher birth weight was the only factor independently associated with a greater drop in HAZ (p<0.001). Shunt type was not associated with WAZ or HAZ at 6 years of age. Conclusions: Children with HLHS remain short and underweight at 6 years of age with twice as many subjects being <-2 for HAZ compared to the proportion with WAZ <-2. Cumulative LOS (a surrogate for surgical and medical morbidity) was associated with poorer weight gain. In the current analysis, we did not identify any modifiable factors associated with growth at age 6 years.