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Growth after neonatal arterial switch operation for D-transposition of the great arteries
L Rosti1, A Frigiola, R M Bini
1Department of Pediatric Cardiology and Heart Surgery, Istituto Policlinico San Donato, San Donato Milanese, Italy.
Insights
Infants with d-transposition of the great arteries (d-TGA) show initial growth deficits after anatomical correction surgery. However, weight and height typically normalize by 12 months, while head growth lags, though motor development remains unaffected.
Area of Science:
- Pediatric Cardiology
- Neonatal Surgery
- Developmental Pediatrics
Background:
- d-transposition of the great arteries (d-TGA) is a critical congenital heart defect.
- Early neonatal anatomical correction (switch operation) is a standard treatment for d-TGA.
- Post-surgical growth patterns in infants with d-TGA require detailed evaluation.
Purpose of the Study:
- To assess the growth trajectory of infants following early neonatal switch operation for d-TGA.
- To compare post-operative growth parameters (weight, height, head circumference) with normative data.
- To identify specific patterns or delays in infant growth after d-TGA correction.
Main Methods:
- Retrospective analysis of growth data from 23 infants with d-TGA post-switch operation.
- Data collection at birth and at 1, 3, 6, 12, and 24 months of age.
- Transformation of growth measures into z scores for comparison with age-matched references.
Main Results:
- Infants exhibited low z scores for weight, height, and head circumference immediately following surgery.
- Weight and height z scores trended towards normalization between 6 and 12 months, becoming positive by 24 months.
- Head circumference z scores remained negative at 24 months, indicating a persistent lag in head growth.
Conclusions:
- Anatomical correction for d-TGA in neonates leads to a characteristic growth pattern with catch-up growth in weight and height by 12 months.
- Head growth demonstrates a distinct, slower recovery pattern compared to somatic growth.
- Despite initial growth variations, gross motor development appears unaffected in this cohort.
Abstract:
The objective of this study was to evaluate growth in infants with d-transposition of the great arteries (d-TGA) who underwent switch operation (anatomical correction) in the early neonatal period. Growth data (at birth and 1, 3, 6, 12, and 24 months of age) were retrieved in 23 infants with d-TGA who survived the operation without major complications. Measures were transformed into z scores and compared with normative data for age. Following surgery, infants showed low z scores for weight, height, and head circumference. Weight and height showed a trend to reach normal ranges between 6 and 12 months of age, and the z scores were positive at 24 months. z scores for head circumference were still negative at 24 months of age. No dietary interventions were implemented during this period, and the infants were fed their own mothers' milk or, before discharge, high-calorie, preterm formula. Following anatomical correction for d-TGA in the early neonatal period, infant growth shows a characteristic pattern, with parameters normalized by 12 months of age in most cases. Head growth shows a different pattern, although gross motor development seems unaffected.