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Published on: February 10, 2022
New insights on growth trajectory in infants with complex congenital heart disease
Amy Jo Lisanti1, Jungwon Min2, Nadya Golfenshtein3
1Department of Family and Community Health, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104, United States of America; Research Institute, Children's Hospital of Philadelphia, 734 Schuylkill Ave, Philadelphia, PA 19146, United States of America.
Insights
Infants with complex congenital heart disease (cCHD) show varied weight-for-age Z-score growth trajectories (WAZ-GT) post-surgery. Identifying risk factors like feeding and hospital stay aids early intervention for better growth outcomes.
Area of Science:
- Pediatric Cardiology
- Neonatal Health
- Growth Monitoring
Background:
- Infants with complex congenital heart disease (cCHD) face significant growth challenges post-neonatal surgery.
- Weight-for-age Z-score growth trajectory (WAZ-GT) is a critical indicator of infant health and development.
- Understanding early growth patterns is crucial for timely interventions in this vulnerable population.
Purpose of the Study:
- To describe the weight-for-age Z-score growth trajectory (WAZ-GT) in infants with cCHD during the first 4 months after neonatal cardiac surgery.
- To identify clinical and sociodemographic risk factors associated with different WAZ-GT patterns.
Main Methods:
- Utilized data from 178 infants with cCHD from a telehealth home monitoring trial (NCT01941667).
- Calculated weekly WAZ and employed latent class growth modeling to identify WAZ-GT classes.
- Used multinomial logistic regression to analyze associations between risk factors and WAZ-GT classes.
Main Results:
- Identified four distinct WAZ-GT classes: maintaining WAZ > 0 (14%), stable around WAZ = 0 (35%), partially recovered (28%), and never recovered (23%).
- Factors associated with better growth included biventricular physiology, borderline appetite, and parental college education.
- Factors linked to poorer growth included longer hospital stays, tube feeding, low appetite, and being a single child.
Conclusions:
- Distinct WAZ-GT classes exist in infants with cCHD early in life, with identifiable determinants.
- These findings can help identify at-risk infants and inform the design of targeted growth interventions.
- Early growth monitoring and risk factor assessment are vital for improving outcomes in infants with cCHD.
Purpose:
We aimed to describe the weight-for-age Z-score growth trajectory (WAZ-GT) of infants with complex congenital heart disease (cCHD) after neonatal cardiac surgery in the first 4 months of life and assess potential risk factors.
Methods:
We utilized data from a previously reported trial of the REACH telehealth home monitoring (NCT01941667) program which evaluated 178 infants with cCHD from 2012 to 2017. Over the first 4 months of life, weekly infant weights were converted to WAZ. WAZ-GT classes were identified using latent class growth modeling. Multinomial logistic regression models were used to examine the associations between potential risk factors and WAZ-GT classes.
Results:
Four distinct classes of WAZ-GT were identified: maintaining WAZ > 0, 14%; stable around WAZ = 0, 35%; partially recovered, 28%; never recovered, 23%. Compared with reference group "stable around WAZ=0," we identified clinical and sociodemographic determinants of class membership for the three remaining groups. "Maintaining WAZ > 0" had greater odds of having biventricular physiology, borderline appetite, and a parent with at least a college education. "Partially recovered" had greater odds of hospital length of stay>14 days and being a single child in the household. "Never recovered" had greater odds hospital length of stay >14 and > 30 days, tube feeding at discharge, and low appetite.
Conclusions:
This study described distinct classes of WAZ-GT for infants with cCHD early in infancy and identified associated determinants.
Practice Implications:
Findings from this study can be used in the identification of infants at risk of poor WAZ-GT and in the design of interventions to target growth in this vulnerable patient population.
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