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Impact of pharmacotherapy on interstage mortality and weight gain in children with single ventricle

Sunil J Ghelani1, Christopher F Spurney, Gerard R Martin

  • 1Division of Cardiology, Children's National Medical Center, W111 Michigan Avenue NW, Washington, DC 20010, USA.

Congenital Heart Disease
|November 20, 2012
PubMed

Insights

Infants with single ventricle defects face high mortality and poor growth. This study found no single medication improved outcomes, and a higher medication burden correlated with worse growth in these children.

Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Disease
  • Pharmacotherapy Research

Background:

  • Infants with single ventricle physiology experience significant mortality and impaired somatic growth between surgical palliation stages.
  • Managing these complex patients involves a substantial medication regimen, raising questions about its efficacy and impact.

Purpose of the Study:

  • To retrospectively evaluate the impact of pharmacotherapy on interstage mortality and somatic growth in infants with single ventricle physiology.
  • To identify specific medications or medication burden associated with clinical outcomes.

Main Methods:

  • Retrospective analysis of a multicenter database including 395 infants with single ventricle physiology.
  • Assessment of interstage mortality and changes in weight-for-age z-score as primary outcomes.
  • Statistical analysis including univariable and regression analyses to determine medication impact.

Main Results:

  • Interstage mortality was 9.4%. While digoxin showed a univariable association with lower mortality risk, no single medication was an independent predictor.
  • A significant proportion of patients (36.3%) experienced decreased weight-for-age z-scores during the interstage period.
  • Increased total medication burden negatively correlated with interstage growth (change in z-score). Specific agents like metoclopramide and lansoprazole were associated with decreased z-scores on univariable analysis but not independently.

Conclusions:

  • Infants with single ventricle physiology carry a high mortality risk and are prescribed a considerable number of medications.
  • No individual medication demonstrated independent association with improved survival or somatic growth during the interstage period.
  • Widespread use of proton pump inhibitors and prokinetic agents did not correlate with better outcomes and may be linked to poorer growth.

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