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Normal interstage growth after the norwood operation associated with interstage home monitoring
David A Hehir1, Nancy Rudd, Julie Slicker
1Division of Pediatric Critical Care, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, 53201, USA. dhehir@mcw.edu
Insights
A home-monitoring program (HMP) helps infants achieve normal growth after stage 1 palliation (S1P). This approach improves interstage growth and survival rates for high-risk infants undergoing complex cardiac procedures.
Area of Science:
- Pediatric Cardiology
- Growth and Development
- Congenital Heart Disease
Background:
- Infants undergoing stage 1 palliation (S1P) often experience growth failure in the interstage period.
- This interstage growth failure is linked to poorer clinical outcomes.
- Effective nutritional management is crucial for improving growth in these high-risk patients.
Purpose of the Study:
- To evaluate the growth patterns of infants in an interstage home-monitoring program (HMP).
- To identify risk factors associated with poor interstage growth.
- To assess the impact of the HMP on interstage survival.
Main Methods:
- A retrospective review of 148 infants enrolled in an HMP after S1P between 2000 and 2009.
- Daily weight monitoring by families with alerts for nutritional protocol violations.
- Analysis of interstage growth velocity and weight-for-age z-scores compared to CDC norms.
Main Results:
- Interstage survival rate was 98% (145/148).
- Average interstage growth velocity was 26 ± 8 g/day.
- Weight-for-age z-scores improved during the interstage period after an initial decline post-S1P.
Conclusions:
- An HMP utilizing a multidisciplinary approach supports normal interstage growth velocity.
- Factors like male gender, higher birth weight, and full oral feeding at discharge correlate with improved growth.
- Daily monitoring and a structured feeding protocol are associated with excellent interstage growth and survival.
Abstract:
After stage 1 palliation (S1P) with a Norwood operation, infants commonly experience growth failure during the initial interstage period. Growth failure during this high-risk period is associated with worse outcomes. This study evaluated the growth patterns of patients enrolled in the authors' interstage home-monitoring program (HMP), which uses a multidisciplinary team approach to nutrition management. From 2000 to 2009, 148 infants were enrolled in the HMP after S1P. Families recorded daily weights during the interstage period and alerted the interstage monitoring team about protocol violations of nutritional goals. Interstage monitoring and inpatient data from the S1P hospitalization were reviewed to identify risk factors for poor growth. Growth outcomes were compared with published norms from the Centers for Disease Control. Interstage survival for patients in the HMP was 98 % (145/148). Growth velocity during the interstage period was 26 ± 8 g/day. The weight-for-age z-scores decreased from birth to discharge after S1P (-0.4 ± 0.9 to -1.3 ± 0.9; p < 0.001) but then increased during the interstage period to the time of S2P (-0.9 ± 1; p < 0.001). The factors associated with improved growth during the interstage period included male gender, greater birth weight, full oral feeding at S1P discharge, and a later birth era. After S1P, infants enrolled in an HMP experienced normal growth velocity during the interstage period. Daily observation of oxygen saturation, weight change, and enteral intake together with implementation of a multidisciplinary feeding protocol is associated with excellent interstage growth and survival.
