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Growth Asymmetry, Head Circumference, and Neurodevelopmental Outcomes in Infants with Single Ventricles
Thomas A Miller1, Victor Zak2, Peter Shrader2
1Department of Pediatrics, University of Utah, Salt Lake City, UT.
Insights
Growth asymmetry in infants with single ventricle (SV) did not correlate with neurodevelopmental outcomes. However, head circumference-for-age z-score (HCAZ) before surgery was linked to psychomotor development, suggesting it
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Growth and Development Studies
Background:
- Infants with single ventricle (SV) physiology often experience altered growth patterns.
- Understanding growth variability is crucial for predicting neurodevelopmental trajectories in these high-risk infants.
- The role of asymmetric growth as a potential brain-sparing mechanism in SV infants remains unclear.
Purpose of the Study:
- To investigate the variability of asymmetric growth in infants with SV.
- To determine the association between asymmetric growth indices and neurodevelopmental outcomes at 14 months of age.
- To explore whether asymmetric growth serves as a brain-sparing adaptation in this population.
Main Methods:
- Prospective enrollment in the Infant Single Ventricle Trial.
- Analysis of weight-for-age z-score minus head circumference-for-age z-score (HCAZ) and relative head growth.
- Assessment of neurodevelopment using the Bayley Scales of Infant Development-II (BSID-II) Psychomotor Developmental Index (PDI) and Mental Developmental Index (MDI) at 14 months.
Main Results:
- Indices of asymmetric growth showed wide variability in infants before superior cavopulmonary connection (SCPC) surgery.
- No significant association was found between asymmetric growth indices and overall BSID-II scores.
- Higher pre-SCPC HCAZ and increased HCAZ from enrollment to pre-SCPC correlated with better PDI scores.
- Pre-SCPC HCAZ independently predicted PDI, but not MDI.
Conclusions:
- Asymmetric growth in infants with SV is not associated with neurodevelopmental outcomes at 14 months.
- Pre-operative HCAZ is linked to psychomotor development (PDI) in infants with SV.
- Asymmetric growth does not appear to function as a brain-sparing adaptation in infants with SV.
Objective:
To assess the variability in asymmetric growth and its association with neurodevelopment in infants with single ventricle (SV).
Study Design:
We analyzed weight-for-age z-score minus head circumference-for-age z-score (HCAZ), relative head growth (cm/kg), along with individual growth variables in subjects prospectively enrolled in the Infant Single Ventricle Trial. Associations between growth indices and scores on the Psychomotor Developmental Index (PDI) and Mental Developmental Index (MDI) of the Bayley Scales of Infant Development-II (BSID-II) at 14 months were assessed.
Results:
Of the 230 subjects enrolled in the Infant Single Ventricle trial, complete growth data and BSID-II scores were available in 168 (73%). Across the cohort, indices of asymmetric growth varied widely at enrollment and before superior cavopulmonary connection (SCPC) surgery. BSID-II scores were not associated with these asymmetry indices. In bivariate analyses, greater pre-SCPC HCAZ correlated with higher MDI (r = 0.21; P = .006) and PDI (r = 0.38; P < .001) and a greater HCAZ increase from enrollment to pre-SCPC with higher PDI (r = 0.15; P = .049). In multivariable modeling, pre-SCPC HCAZ was an independent predictor of PDI (P = .03), but not MDI.
Conclusion:
In infants with SV, growth asymmetry was not associated with neurodevelopment at 14 months, but pre-SCPC HCAZ was associated with PDI. Asymmetric growth, important in other high-risk infants, is not a brain-sparing adaptation in infants with SV.
Trial Registration:
Clinicaltrials.gov: NCT00113087.
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