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

Published online by Cambridge University Press:  08 October 2012

Andrew W. McCrary ,
Martha L. Clabby  and
William T. Mahle
Andrew W. McCrary
Affiliation:
Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
Martha L. Clabby
Affiliation:
Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America Department of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States of America
William T. Mahle*
Affiliation:
Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America Department of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States of America
*
Correspondence to: Dr W. T. Mahle, MD, Children's Healthcare of Atlanta, Emory University School of Medicine, 1405 Clifton Road, Northeast Atlanta, Georgia 30322-1062, United States of America. Tel: +1 404 315 2672; Fax: +1 404 325 6021; E-mail: mahlew@kidsheart.com
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Abstract

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.

Keywords

Weight gaincongenital heart diseasenutrition infantoutpatient management
Type
Original Articles
Information
Cardiology in the Young , Volume 23 , Issue 4 , August 2013 , pp. 499 - 506
Copyright
Copyright © Cambridge University Press 2012 

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