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Factors affecting growth in infants with single ventricle physiology: a report from the Pediatric Heart Network
Richard V Williams1, Victor Zak, Chitra Ravishankar
1Department of Pediatrics, University of Utah, Salt Lake City, UT, USA. richard.williams@imail.org
Insights
Infants with single ventricle physiology show growth improvements with aggressive nutritional support and earlier superior cavopulmonary connection (SCPC) surgery. These factors positively influence weight-for-age z-scores, indicating better growth trajectories.
Area of Science:
- Pediatric Cardiology
- Growth and Development
- Congenital Heart Disease
Background:
- Infants with single ventricle physiology often experience growth challenges.
- Understanding growth patterns is crucial for optimizing management strategies.
- Previous studies highlight the complexity of growth in these infants.
Purpose of the Study:
- To describe growth patterns in infants with single ventricle physiology.
- To identify factors influencing growth trajectories in this population.
Main Methods:
- Analysis of data from 230 infants in the Pediatric Heart Network Infant Single Ventricle Enalapril Trial.
- Assessment of weight-for-age z-score changes from enrollment to pre-superior cavopulmonary connection (SCPC) and to final visit.
- Multivariable regression modeling incorporating patient characteristics, feeding, and medical factors.
Main Results:
- During the neonatal period (period 1), factors like higher gestational age and tube feeding at discharge were linked to poorer growth (negative z-score change).
- For the period leading up to and after SCPC surgery (period 2), younger age at SCPC and higher caloric intake were associated with improved growth (positive z-score change).
Conclusions:
- Aggressive nutritional support is a key modifiable factor for improving growth in infants with single ventricle physiology.
- Earlier superior cavopulmonary connection (SCPC) surgery is also associated with favorable growth outcomes.
- These findings provide actionable insights for clinical management to enhance growth in this vulnerable population.
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.
