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Pattern of head circumference growth following bidirectional Glenn in infants with single ventricle heart disease
Stephanie Y Tseng1, Julia Anixt2, Jareen Meinzen-Derr3
1Department of Pediatrics, University of Cincinnati College of Medicine, Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Insights
Infants with single ventricle heart disease show significant head growth after bidirectional Glenn surgery, but this accelerated growth does not predict later motor development outcomes in the first year.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Neurodevelopmental Outcomes
Background:
- Infants with single ventricle congenital heart disease (SV-CHD) experience head growth after bidirectional Glenn (BDG) surgery.
- The precise trajectory of this head growth and its relationship with neurodevelopment is not well-established.
Purpose of the Study:
- To describe head circumference growth patterns in the first year post-BDG in infants with SV-CHD.
- To investigate the correlation between head growth and motor developmental outcomes at approximately 12 months after BDG.
Main Methods:
- Sixty-nine infants with SV-CHD undergoing BDG were analyzed, excluding those with brain abnormalities or major complications.
- Head circumference and weight were tracked, and motor development assessed using the Bayley Scales of Infant Development.
- Generalized estimating equations were used to analyze changes in head circumference z-scores from baseline to 12 months post-surgery.
Main Results:
- A significant increase in head circumference z-score was observed from baseline (-1.13) to 12 months post-BDG (0.35), with 66.7% of patients showing accelerated growth.
- Accelerated head growth was defined as an increase in z-score greater than 1.
- No significant difference in motor development (Psychomotor Developmental Index) was found between infants with and without accelerated head growth.
Conclusions:
- Single ventricle patients exhibit significant head growth in the first year after BDG, with stabilization around 10-12 months.
- Accelerated head growth post-BDG does not appear to be a predictor of subsequent motor developmental outcomes in this cohort.
Background:
Infants with single ventricle congenital heart disease demonstrate increasing head growth after bidirectional Glenn; however, the expected growth trajectory has not been well described.
Aims:
1) We will describe the pattern of head circumference growth in the first year after bidirectional Glenn. 2) We will determine if head growth correlates with motor developmental outcomes approximately 12 months after bidirectional Glenn.
Methods:
Sixty-nine single ventricle patients underwent bidirectional Glenn between 2010 and 2016. Patients with structural brain abnormalities, grade III-IV intra-ventricular haemorrhage, significant stroke, or obstructive hydrocephalus were excluded. Head circumference and body weight measurements from clinical encounters were evaluated. Motor development was measured with Psychomotor Developmental Index of the Bayley Scales of Infant Development, Third Edition. Generalised estimating equations assessed change in head circumference z-scores from baseline (time of bidirectional Glenn) to 12 months post-surgery.
Results:
Mean age at bidirectional Glenn was 4.7 (2.3) months and mean head circumference z-score based on population-normed data was -1.13 (95% CI -1.63, -0.63). Head circumference z-score increased to 0.35 (95% CI -0.20, 0.90) (p < 0.0001) 12 months post-surgery. Accelerated head growth, defined as an increase in z-score of >1 from baseline to 12 months post-surgery, was present in 46/69 (66.7%) patients. There was no difference in motor Psychomotor Developmental Index scores between patients with and without accelerated head growth.
Conclusion:
Single ventricle patients demonstrated a significant increase in head circumference after bidirectional Glenn until 10-12 months post-surgery, at which time growth stabilised. Accelerated head growth did not predict sub-sequent motor developmental outcomes.
