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Impact of pharmacotherapy on interstage outcomes in single ventricle infants

Brady S Moffett1, Raphael Mattamal, Elena C Ocampo

  • 1Department of Pharmacy, Texas Children's Hospital, Houston, TX 77030, USA. bsmoffet@texaschildrens.org

Congenital Heart Disease
|June 24, 2011
PubMed

Insights

Infants with single ventricle heart disease face a high medication burden between surgeries. Current drug regimens, including digoxin and high-dose furosemide, do not appear to improve interstage weight gain in these vulnerable patients.

Area of Science:

  • Pediatric Cardiology
  • Pharmacology
  • Congenital Heart Disease

Background:

  • Single ventricle heart disease (SVHD) requires staged surgical palliation.
  • The interstage period between surgical palliation stages is critical for infant growth.
  • Optimizing pharmacotherapeutic regimens is essential for improving outcomes in SVHD infants.

Purpose of the Study:

  • To characterize medication use in infants with SVHD during the interstage period.
  • To determine the impact of outpatient medications on interstage weight gain.
  • To identify factors influencing somatic growth in SVHD infants.

Main Methods:

  • Retrospective review of 161 SVHD patients undergoing neonatal surgical palliation (2002-2009).
  • Analysis of outpatient medication regimens during the interstage period.
  • Logistic and linear regression models to assess medication effects on weight-for-age z-score (WAZ) and daily weight gain.

Main Results:

  • Patients received a median of four medications, commonly aspirin, furosemide, and ACE inhibitors.
  • Most patients (71%) experienced a decrease in WAZ during the interstage period.
  • Digoxin and high-dose furosemide were associated with decreased WAZ; ACE-I and other GI medications showed no benefit.

Conclusions:

  • Infants with SVHD have a significant medication burden during the interstage period.
  • Current pharmacotherapeutic strategies show limited efficacy in improving interstage weight gain.
  • Further research is needed to optimize medical management for SVHD infants.
Abstract

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