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Published on: January 27, 2023
Patient and practice factors affecting growth of infants with systemic-to-pulmonary shunt
Andrew W McCrary1, Martha L Clabby, William T Mahle
1Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30322-1062, United States of America.
Insights
Neonatal patients with systemic-to-pulmonary shunts experienced significant weight drop post-surgery. Cardiologist-led nutritional interventions are crucial for optimizing weight gain in these vulnerable infants.
Area of Science:
- Pediatric Cardiology
- Neonatal Surgery
- Growth Monitoring
Background:
- Neonatal palliation with systemic-to-pulmonary shunts can lead to poor patient growth.
- Understanding factors influencing growth post-surgery is critical for improving outcomes.
Purpose of the Study:
- To investigate patient- and procedure-related factors affecting growth in neonates after systemic-to-pulmonary shunt.
- To evaluate the role of the primary cardiologist in managing growth.
Main Methods:
- Retrospective review of 133 neonates undergoing modified systemic-to-pulmonary artery shunts (2002-2009).
- Comparison of weight-for-age z-scores between single- and two-ventricle circulations.
- Analysis of outpatient visit data and nutritional interventions.
Main Results:
- Single-ventricle patients showed a greater drop in weight-for-age z-score from surgery to the first outpatient visit.
- Lower frequency of nutritional interventions by cardiologists was significantly linked to poorer growth.
- Growth was not significantly associated with race, feeding tube use, formula type, or proximity to the surgical center.
Conclusions:
- A significant weight drop suggests potential nutritional inadequacy in neonates post-shunt.
- The primary cardiologist plays a vital role in optimizing infant weight gain through dietary management.
- Timely nutritional adjustments are essential for improving growth outcomes in this population.
Background:
On recognising poor growth following neonatal palliation with a systemic-to-pulmonary shunt, we sought to determine how patient- and procedure-related factors impact growth, paying attention to the role of the primary cardiologist in this process.
Methods:
In a retrospective review, neonates (133 patients) receiving modified systemic-to-pulmonary artery shunts from 2002 to 2009 were studied and outpatient visits were reviewed. Patients with single- and two-ventricle circulations after shunt takedown were compared using weight-for-age z-score.
Results:
Single-ventricle patients had a higher weight-for-age z-score at neonatal surgery than two-ventricle patients (-0.4 ± 1.0 compared with -1.2 ± 0.9, with p < 0.001), but they had a greater drop in the weight-for-age z-score to the first outpatient visit (-1.1 ± 0.7 compared with -0.8 ± 0.7, with p = 0.02). After the first outpatient visit, the weight-for-age z-score was not significantly different between single-ventricle and two-ventricle patients. From multivariate analysis, a lower number of nutritional interventions by cardiologists was significantly associated with poor growth (p = 0.03). Poor growth was not associated with race, use of feeding tube, exclusive formula use, or proximity to surgical centre.
Conclusion:
The significant drop in the weight-for-age z-score from neonatal surgery to first outpatient visit suggests that these patients may receive inadequate nutrition. The poorest performers received the least number of outpatient changes to their diet. This finding underscores the critical role of the primary cardiologist in optimising weight gain through adjustments in nutrition.
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