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Weight change in infants with a functionally univentricular heart: from surgical intervention to hospital discharge

Published online by Cambridge University Press:  12 November 2010

Barbara Medoff-Cooper*
Affiliation:
Department of Pediatrics, The Children’s Hospital of Philadelphia and School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
Sharon Y. Irving
Affiliation:
School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
Bradley S. Marino
Affiliation:
The Heart Institute Research Core at Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
J. Felipe García-España
Affiliation:
Department of Pediatrics, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
Chitra Ravishankar
Affiliation:
Department of Cardiology, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
Geoffrey L. Bird
Affiliation:
Department of Critical Care, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
Virginia A. Stallings
Affiliation:
Department of Pediatrics, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
*
Correspondence to: B. Medoff-Cooper, RN, PhD, FAAN, Ruth M. Colket Professor in Pediatric Nursing, The Children’s Hospital of Philadelphia, Professor, University of Pennsylvania, School of Nursing, 418 Curie Boulevard, Claire M. Fagin Hall, Philadelphia, Pennsylvania 19104, United States of America. Tel: 215 898 3399; Fax: 215 898 3056; E-mail: medoff@nursing.upenn.edu

Abstract

Objective

The purpose of this study was to assess the pattern of weight change from surgical intervention to home discharge and to determine predictors of poor growth in this population of infants with congenital cardiac disease.

Methods

Neonates with functionally univentricular physiology enrolled in a prospective cohort study examining growth between March, 2003 and May, 2007 were included. Weights were collected at birth, before surgical intervention, and at hospital discharge. In addition, retrospective echocardiographic data and data about post-operative complications were reviewed. Primary outcome variables were weight-for-age z-score at discharge and change in weight-for-age z-score between surgery and discharge.

Results

A total of 61 infants met the inclusion criteria. The mean change in weight-for-age z-score between surgery and hospital discharge was minus 1.5 plus or minus 0.8. Bivariate analysis revealed a significant difference in weight-for-age z-score between infants who were discharged on oral feeds, minus 1.1 plus or minus 0.8 compared to infants with feeding device support minus 1.7 plus or minus 0.7, p-value equal to 0.01. Lower weight-for-age z-score at birth, presence of moderate or greater atrioventricular valve regurgitation, post-operative ventilation time, and placement of an additional central venous line were associated with 60% of the variance in weight-for-age z-score change.

Conclusion

Neonates undergoing staged surgical repair for univentricular physiology are at significant risk for growth failure between surgery and hospital discharge. Haemodynamically significant atrioventricular valve regurgitation and a complex post-operative course were risk factors for poor post-operative weight gain. Feeding device support appears to be insufficient to ensure adequate weight gain during post-operative hospitalisation.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2010

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