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Site of interstage outpatient care and growth after the Norwood operation
Mehul D Patel1, Karen Uzark1, Sunkyung Yu1
11Division of Pediatric Cardiology,Department of Pediatrics and Communicable Diseases,University of Michigan,C. S. Mott Children's Hospital,Ann Arbor,MI,United States of America.
Insights
The location of interstage care did not impact weight gain in infants after the Norwood operation. Nearly one-third of infants still had poor weight gain at Stage 2, requiring further research for optimized nutritional support.
Area of Science:
- Pediatric Cardiology
- Surgical Outcomes
- Infant Growth and Development
Background:
- Optimizing interstage outcomes, including growth, is crucial for infants following the Norwood operation.
- The influence of interstage care location on infant growth remains uncertain.
- Hypotheses suggest surgical site care may improve outcomes due to enhanced resource access, such as nutritional support.
Purpose of the Study:
- To evaluate the association between the site of interstage care and weight gain in a large, multicenter cohort of infants.
- To determine if care at the surgical site, compared to a non-surgical site, leads to better weight gain.
- To analyze the impact of interstage care location on weight-for-age z-scores.
Main Methods:
- Infants in the National Paediatric Cardiology Quality Improvement Collaborative (2008-2013) surviving to Stage 2 were analyzed.
- Weight-for-age z-score changes from Norwood discharge to Stage 2 admission were compared between infants receiving care at surgical versus non-surgical sites.
- Multivariable analysis adjusted for baseline characteristics, interstage duration, and home surveillance strategies.
Main Results:
- No significant difference in weight-for-age z-score change was observed between the surgical site group (+0.36±0.96) and the non-surgical site group (+0.46±1.02).
- These findings remained consistent after multivariable adjustment.
- The proportion of infants with a weight-for-age z-score <-2 decreased from 40% to 29% by Stage 2, with no significant difference between care site groups.
Conclusions:
- The site of interstage care is not associated with weight gain in infants post-Norwood operation.
- A significant proportion of infants (nearly one-third) exhibit poor weight gain by Stage 2.
- Further research is necessary to identify effective strategies for optimizing infant weight gain during the interstage period.
Background:
Recent efforts have focused on optimising interstage outcomes, including growth, for infants following the Norwood operation. The impact of the site of interstage care remains unclear, and it has been hypothesised that care at the surgical site may be beneficial due to greater access to resources such as nutritional support. This study evaluated the relationship between site of interstage care and weight gain in a large multicentre cohort.
Methods:
Infants enrolled in the National Paediatric Cardiology Quality Improvement Collaborative (2008-2013) surviving up to Stage 2 were included. Change in weight-for-age z-score between Norwood discharge and Stage 2 admission was compared in those receiving care at the surgical versus non-surgical site.
Results:
Of the 487 interstage survivors, 60% received all care at the surgical site, and 40% received care at a non-surgical site. There was no significant difference between groups in change in weight-for-age z-score: +0.36±0.96 for the surgical site group versus +0.46±1.02 for the non-surgical site group, p=0.3. Results were unchanged in multivariable analysis adjusting for differences in important baseline characteristics, duration of interstage, and home surveillance strategy. The proportion of all patients with weight-for-age z-score <-2 decreased from 40% at Norwood discharge to 29% at Stage 2, with no significant difference in change between the two groups (p=0.1).
Conclusions:
The site of interstage care was not associated with weight gain during the interstage period. Nearly one-third of patients overall had a weight-for-age z-score <-2 at Stage 2. Further study is required to identify methods to optimise weight gain in these patients.
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