Hemoglobin Level at Stage 1 Discharge has No Impact on Inter-stage Growth and Stability in Single Ventricle Infants

Area of Science:

• Pediatric Cardiology
• Neonatal Medicine
• Congenital Heart Disease Research

Background:

• Infants with single ventricle (SV) physiology often require staged palliation.
• Maintaining high hemoglobin (Hgb) levels is a traditional strategy to optimize oxygen delivery during these stages.
• The benefit of higher Hgb achieved through late transfusions post-stage 1 palliation (S1P) is unclear.

Purpose of the Study:

• To investigate if red blood cell transfusions aiming for higher Hgb levels during the late S1P convalescent phase improve outcomes in infants with SV.
• To assess the association between higher Hgb and improved growth and reduced acute medical events during the interstage period (IS).

Main Methods:

• Retrospective cohort study of 137 infants (<1 year) with SV undergoing S1P.
• Evaluation of data from January 2008 to June 2015.
• Comparison of infants receiving late S1P transfusions versus those who did not, analyzing Hgb levels, growth, and acute events.

Main Results:

• Higher Hgb at S1P discharge was not associated with improved interstage growth (weight/length gain) or fewer acute medical events.
• Late S1P transfusions were associated with greater S1P illness severity and more complex S1P care.
• Median Hgb at S1P discharge was 15.9 g/dL and at S2P admission was 15.3 g/dL.

Conclusions:

• Late transfusions to increase hemoglobin levels in single ventricle infants after stage 1 palliation do not confer benefits for interstage growth or acute events.
• These transfusions may be associated with increased illness severity during S1P.
• Current data suggest that steadily recovering SV infants do not benefit from late transfusions to raise discharge hemoglobin levels.