No CrossRef data available.
Article contents
Impact of calorie intake and weight gain after Norwood procedure on the outcome of stage II palliation
Published online by Cambridge University Press: 06 November 2023
Abstract
Background:
This study aimed to assess the impact of caloric intake and weight-for-age-Z-score after the Norwood procedure on the outcome of bidirectional cavopulmonary shunt.
Methods:
A total of 153 neonates who underwent the Norwood procedure between 2012 and 2020 were surveyed. Postoperative daily caloric intake and weight-for-age-Z-score up to five months were calculated, and their impact on outcome after bidirectional cavopulmonary shunt was analysed.
Results:
Median age and weight at the Norwood procedure were 9 days and 3.2 kg, respectively. Modified Blalock-Taussig shunt was used in 95 patients and right ventricle to pulmonary artery conduit in 58. Postoperatively, total caloric intake gradually increased, whereas weight-for-age-Z-score constantly decreased. Early and inter-stage mortality before stage II correlated with low caloric intake. Older age (p = 0.023) at Norwood, lower weight (p < 0.001) at Norwood, and longer intubation (p = 0.004) were correlated with low weight-for-age-Z-score (< –3.0) at 2 months of age. Patients with weight-for-age-Z-score < –3.0 at 2 months of age had lower survival after stage II compared to those with weight-for-age-Z-score of –3.0 or more (85.3 versus 92.9% at 3 years after stage II, p = 0.017). There was no difference between inter-stage weight gain and survival after bidirectional cavopulmonary shunt between the shunt types.
Conclusion:
Weight-for-age-Z-score decreased continuously throughout the first 5 months after the Norwood procedure. Age and weight at Norwood and intubation time were associated with weight gain. Inter-stage low weight gain (Z-score < –3) was a risk for survival after stage II.
Keywords
- Type
- Original Article
- Information
- Copyright
- © The Author(s), 2023. Published by Cambridge University Press
Footnotes
Presented at the 59th Annual Meeting of the Society of Thoracic Surgeons, San Diego, California, January 21–23, 2023.
References
Shenoy, RU, Parness, IA. Hypoplastic left heart syndrome: looking back, looking forward. J Am Coll Cardiol 2014; 64: 2036–2038.CrossRefGoogle ScholarPubMed
Ohye, RG, Schranz, D, D’Udekem, Y. Current therapy for hypoplastic left heart syndrome and related single ventricle lesions. Circulation 2016; 134: 1265–1279.CrossRefGoogle ScholarPubMed
Mascio, CE, Irons, ML, Ittenbach, RF, et al. Thirty years and 1663 consecutive Norwood procedures: has survival plateaued? J Thorac Cardiovasc Surg 2019; 158: 220–229.CrossRefGoogle ScholarPubMed
Ono, M, Kido, T, Wallner, M, et al. Comparison of shunt types in the neonatal Norwood procedure for single ventricle. Eur J Cardiothorac Surg 2021; 60: 1084–1091.CrossRefGoogle ScholarPubMed
Piber, N, Ono, M, Palm, J, et al. Influence of shunt type on survival and right heart function after the Norwood procedure for aortic atresia. Semin Thorac Cardiovasc Surg 2022; 34: 1300–1310.CrossRefGoogle ScholarPubMed
Staehler, H, Ono, M, Schober, P, et al. Clinical and haemodynamic variables associated with intensive care unit length of stay and early adverse outcomes after the Norwood procedure. Eur J Cardiothorac Surg 2022; 61: 1271–1280.CrossRefGoogle ScholarPubMed
Wolovits, JS, Torzone, A. Feeding and nutritional challenges in infants with single ventricle physiology. Curr Opin Pediatr 2012; 24: 295–300.10.1097/MOP.0b013e32835356aeCrossRefGoogle ScholarPubMed
Brief, F, Guimber, D, Baudelet, JB, et al. Prevalence and associated factors of long-term growth failure in infants with congenital heart disease who underwent cardiac surgery before the age of one. Pediatr Cardiol 2022; 43: 1681–1687.CrossRefGoogle ScholarPubMed
Van den Eynde, J, Bartelse, S, Rijnberg, FM, et al. Somatic growth in single ventricle patients: a systematic review and meta-analysis. Acta Paediatr 2023; 112: 186–199.CrossRefGoogle ScholarPubMed
Chan, FT, Bellsham-Revell, HR, Duggan, H, Simpson, JM, Hulse, T, Bell, AJ. Interstage somatic growth in children with hypoplastic left heart syndrome after initial palliation with the hybrid procedure. Cardiol Young 2017; 27: 131–138.CrossRefGoogle ScholarPubMed
Slicker, J, Hehir, DA, Horsley, M, et al. Nutrition algorithms for infants with hypoplastic left heart syndrome; birth through the first interstage period. Congenit Heart Dis 2013; 8: 89–102.CrossRefGoogle ScholarPubMed
Kelleher, DK, Laussen, P, Teixeira-Pinto, A, Duggan, C. Growth and correlates of nutritional status among infants with hypoplastic left heart syndrome (HLHS) after stage 1 Norwood procedure. Nutrition 2006; 22: 237–244.CrossRefGoogle ScholarPubMed
Hong, BJ, Moffett, B, Payne, W, Rich, S, Ocampo, EC, Petit, CJ. Impact of postoperative nutrition on weight gain in infants with hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 2014; 147: 1319–1325.CrossRefGoogle ScholarPubMed
Steward, DK, Ryan-Wenger, N, Harrison, TM, Pridham, KF. Patterns of growth and nutrition from birth to 6 Months in infants with complex congenital cardiac defects. Nurs Res 2020; 69: S57–S65.CrossRefGoogle ScholarPubMed
Schreiber, C, Cleuziou, J, Cornelsen, JK, Hörer, J, Eicken, A, Lange, R. Bidirectional cavopulmonary connection without additional pulmonary blood flow as an ideal staging for functional univentricular hearts. Eur J Cardiothorac Surg 2008; 34: 550–554.10.1016/j.ejcts.2008.04.043CrossRefGoogle ScholarPubMed
Ono, M, Mayr, B, Burri, M, et al. Tricuspid valve repair in children with hypoplastic left heart syndrome: impact of timing and mechanism on outcome. Eur J Cardiothorac Surg 2020; 57: 1083–1090.CrossRefGoogle ScholarPubMed
Joosten, K, Embleton, N, Yan, W, Senterre, T. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: energy. Clin Nutr 2018; 37: 2309–2314.CrossRefGoogle ScholarPubMed
Luo, WY, Xu, ZM, Zhang, YY, Hong, L, Zhang, MJ, Zhang, YQ. The nutritional status of pediatric patients with single ventricle undergoing a bidirectional Glenn procedure. Pediatr Cardiol 2020; 41: 1594–1600.10.1007/s00246-020-02416-wCrossRefGoogle ScholarPubMed
Moza, R, Truong, DT, Lambert, LM, et al. Poor weight recovery between Stage 1 Palliation and hospital discharge for infants with single ventricle physiology: an analysis of the national pediatric cardiology quality improvement collaborative phase II dataset. J Pediatr 2021; 234: 20–26.e2.CrossRefGoogle ScholarPubMed
Lambert, LM, Pike, NA, Medoff-Cooper, B, et al. Pediatric heart network investigators. Variation in feeding practices following the Norwood procedure. J Pediatr 2014; 164: 237–242.CrossRefGoogle ScholarPubMed
Granegger, M, Küng, S, Bollhalder, O, et al. Serial assessment of somatic and cardiovascular development in patients with single ventricle undergoing Fontan procedure. Int J Cardiol 2021; 322: 135–141.CrossRefGoogle ScholarPubMed
Williams, RV, Zak, V, Ravishankar, C, et al. Pediatric heart network investigators. Factors affecting growth in infants with single ventricle physiology: a report from the pediatric heart network infant single ventricle trial. J Pediatr 2011; 159: 1017–1022.CrossRefGoogle ScholarPubMed
Anderson, JB, Beekman, RH3rd, Eghtesady, P. Predictors of poor weight gain in infants with a single ventricle. J Pediatr 2010; 157: 407–413.CrossRefGoogle ScholarPubMed
Nicholson, GT, Clabby, ML, Kanter, KR, Mahle, WT. Caloric intake during the perioperative period and growth failure in infants with congenital heart disease. Pediatr Cardiol 2013; 34: 316–321.CrossRefGoogle ScholarPubMed
Baldini, L, Librandi, K, D'Eusebio, C, Lezo, A. Nutritional management of patients with fontan circulation: a potential for improved outcomes from birth to adulthood. Nutrients 2022; 1 4: 4055.10.3390/nu14194055CrossRefGoogle Scholar
Van den Eynde, J, Bartelse, S, Rijnberg, FM, et al. Somatic growth in single ventricle patients: a systematic review and meta-analysis. Acta Paediatr 2023; 112: 186–199.CrossRefGoogle ScholarPubMed
Ono, M, Burri, M, Mayr, B, et al. Risk factors for failed Fontan procedure after Stage 2 Palliation. Ann Thorac Surg 2021; 112: 610–618.CrossRefGoogle ScholarPubMed
Sethi, SK, Goyal, D, Yadav, DK, et al. Predictors of acute kidney injury post-cardiopulmonary bypass in children. Clin Exp Nephrol 2011; 15: 529–534.CrossRefGoogle ScholarPubMed
Hehir, DA, Cooper, DS, Walters, EM, Ghanayem, NS. Feeding, growth, nutrition, and optimal interstage surveillance for infants with hypoplastic left heart syndrome. Cardiol Young 2011; 21: 59–64.CrossRefGoogle ScholarPubMed
Chaves, AH, Baker-Smith, CM, Rosenthal, GL. Arch intervention following stage 1 palliation in hypoplastic left heart syndrome is associated with slower feed advancement: a report from the national pediatric quality cardiology improvement collaborative. Cardiol Young 2020; 30: 396–401.10.1017/S1047951120000177CrossRefGoogle ScholarPubMed
Ross, F, Latham, G, Joffe, D, et al. Preoperative malnutrition is associated with increased mortality and adverse outcomes after paediatric cardiac surgery. Cardiol Young 2017; 27: 1716–1725.10.1017/S1047951117001068CrossRefGoogle ScholarPubMed
Barron, DJ, Haq, IU, Crucean, A, et al. The importance of age and weight on cavopulmonary shunt (stage II) outcomes after the Norwood procedure: planned versus unplanned surgery. J Thorac Cardiovasc Surg 2017; 154: 228–238.10.1016/j.jtcvs.2016.12.036CrossRefGoogle ScholarPubMed
Anderson, JB, Beekman, RH3rd, Border, WL. Lower weight-for-age z score adversely affects hospital length of stay after the bidirectional Glenn procedure in 100 infants with a single ventricle. J Thorac Cardiovasc Surg 2009; 138: 397–404.CrossRefGoogle ScholarPubMed
Vest, AR, Price, LL, Chanda, A, et al. Cardiac cachexia in left ventricular assist device recipients and the implications of weight gain early after implantation. J Am Heart Assoc 2023; 12: e029086.CrossRefGoogle ScholarPubMed
Staehler et al. supplementary material
Staehler et al. supplementary material
File
119.7 KB