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Patient and practice factors affecting growth of infants with systemic-to-pulmonary shunt.

Publication ,  Journal Article
McCrary, AW; Clabby, ML; Mahle, WT
Published in: Cardiol Young
August 2013

BACKGROUND: On recognising poor growth following neonatal palliation with a systemic-to-pulmonary shunt, we sought to determine how patient- and procedure-related factors impact growth, paying attention to the role of the primary cardiologist in this process. METHODS: In a retrospective review, neonates (133 patients) receiving modified systemic-to-pulmonary artery shunts from 2002 to 2009 were studied and outpatient visits were reviewed. Patients with single- and two-ventricle circulations after shunt takedown were compared using weight-for-age z-score. RESULTS: Single-ventricle patients had a higher weight-for-age z-score at neonatal surgery than two-ventricle patients (-0.4 ± 1.0 compared with -1.2 ± 0.9, with p < 0.001), but they had a greater drop in the weight-for-age z-score to the first outpatient visit (-1.1 ± 0.7 compared with -0.8 ± 0.7, with p = 0.02). After the first outpatient visit, the weight-for-age z-score was not significantly different between single-ventricle and two-ventricle patients. From multivariate analysis, a lower number of nutritional interventions by cardiologists was significantly associated with poor growth (p = 0.03). Poor growth was not associated with race, use of feeding tube, exclusive formula use, or proximity to surgical centre. CONCLUSION: The significant drop in the weight-for-age z-score from neonatal surgery to first outpatient visit suggests that these patients may receive inadequate nutrition. The poorest performers received the least number of outpatient changes to their diet. This finding underscores the critical role of the primary cardiologist in optimising weight gain through adjustments in nutrition.

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Published In

Cardiol Young

DOI

EISSN

1467-1107

Publication Date

August 2013

Volume

23

Issue

4

Start / End Page

499 / 506

Location

England

Related Subject Headings

  • Weight Gain
  • Treatment Outcome
  • Transposition of Great Vessels
  • Tetralogy of Fallot
  • Risk Factors
  • Retrospective Studies
  • Pulmonary Atresia
  • Nutritional Status
  • Norwood Procedures
  • Multivariate Analysis
 

Citation

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Chicago
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McCrary, A. W., Clabby, M. L., & Mahle, W. T. (2013). Patient and practice factors affecting growth of infants with systemic-to-pulmonary shunt. Cardiol Young, 23(4), 499–506. https://doi.org/10.1017/S1047951112001382
McCrary, Andrew W., Martha L. Clabby, and William T. Mahle. “Patient and practice factors affecting growth of infants with systemic-to-pulmonary shunt.Cardiol Young 23, no. 4 (August 2013): 499–506. https://doi.org/10.1017/S1047951112001382.
McCrary AW, Clabby ML, Mahle WT. Patient and practice factors affecting growth of infants with systemic-to-pulmonary shunt. Cardiol Young. 2013 Aug;23(4):499–506.
McCrary, Andrew W., et al. “Patient and practice factors affecting growth of infants with systemic-to-pulmonary shunt.Cardiol Young, vol. 23, no. 4, Aug. 2013, pp. 499–506. Pubmed, doi:10.1017/S1047951112001382.
McCrary AW, Clabby ML, Mahle WT. Patient and practice factors affecting growth of infants with systemic-to-pulmonary shunt. Cardiol Young. 2013 Aug;23(4):499–506.
Journal cover image

Published In

Cardiol Young

DOI

EISSN

1467-1107

Publication Date

August 2013

Volume

23

Issue

4

Start / End Page

499 / 506

Location

England

Related Subject Headings

  • Weight Gain
  • Treatment Outcome
  • Transposition of Great Vessels
  • Tetralogy of Fallot
  • Risk Factors
  • Retrospective Studies
  • Pulmonary Atresia
  • Nutritional Status
  • Norwood Procedures
  • Multivariate Analysis