Longitudinal assessment of growth in hypoplastic left heart syndrome: results from the single ventricle reconstruction trial.

Journal Article (Journal Article)

BACKGROUND: We sought to characterize growth between birth and age 3 years in infants with hypoplastic left heart syndrome who underwent the Norwood procedure. METHODS AND RESULTS: We performed a secondary analysis using the Single Ventricle Reconstruction Trial database after excluding patients <37 weeks gestation (N=498). We determined length-for-age z score (LAZ) and weight-for-age z score (WAZ) at birth and age 3 years and change in WAZ over 4 clinically relevant time periods. We identified correlates of change in WAZ and LAZ using multivariable linear regression with bootstrapping. Mean WAZ and LAZ were below average relative to the general population at birth (P<0.001, P=0.05, respectively) and age 3 years (P<0.001 each). The largest decrease in WAZ occurred between birth and Norwood discharge; the greatest gain occurred between stage II and 14 months. At age 3 years, WAZ and LAZ were <-2 in 6% and 18%, respectively. Factors associated with change in WAZ differed among time periods. Shunt type was associated with change in WAZ only in the Norwood discharge to stage II period; subjects with a Blalock-Taussig shunt had a greater decline in WAZ than those with a right ventricle-pulmonary artery shunt (P=0.002). CONCLUSIONS: WAZ changed over time and the predictors of change in WAZ varied among time periods. By age 3 years, subjects remained small and three times as many children were short as were underweight (>2 SD below normal). Failure to find consistent risk factors supports the strategy of tailoring nutritional therapies to patient- and stage-specific targets. CLINICAL TRIAL REGISTRATION URL: http://clinicaltrials.gov/. Unique identifier: NCT00115934.

Full Text

Duke Authors

Cited Authors

  • Burch, PT; Gerstenberger, E; Ravishankar, C; Hehir, DA; Davies, RR; Colan, SD; Sleeper, LA; Newburger, JW; Clabby, ML; Williams, IA; Li, JS; Uzark, K; Cooper, DS; Lambert, LM; Pemberton, VL; Pike, NA; Anderson, JB; Dunbar-Masterson, C; Khaikin, S; Zyblewski, SC; Minich, LL; Pediatric Heart Network Investigators,

Published Date

  • June 23, 2014

Published In

Volume / Issue

  • 3 / 3

Start / End Page

  • e000079 -

PubMed ID

  • 24958780

Pubmed Central ID

  • PMC4309036

Electronic International Standard Serial Number (EISSN)

  • 2047-9980

Digital Object Identifier (DOI)

  • 10.1161/JAHA.114.000079


  • eng

Conference Location

  • England