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Adequate nutritional support is essential for normal infant growth and development. Infants with congenital cardiac disease are known to be at risk for growth failure. We sought to describe perioperative growth in infants undergoing surgical repair of two-ventricle congenital cardiac disease and assess for predictors of their pattern of growth.
Full-term infants who underwent surgical repair of two-ventricle congenital cardiac disease at a single institution were enrolled in a retrospective cohort study performed following a larger prospective study. Infants with facial, gastrointestinal, or neurologic anomalies, trisomy chromosomal abnormality, birth weight less than 2500 grams, or those transferred to another institution before discharge home were excluded. The primary outcome was change in weight-for-age z score from surgery to discharge. Our secondary outcome variable was post-operative hospital length of stay.
A total of 76 infants met the inclusion criteria. Medain age at surgery was 5 days with a range from 1 to 44. The median weight-for-age z score at surgery was −0.2 with a range from −2.9 to 2.8 and by discharge had dropped to −1.2 with a range from −3.4 to 1.8. The median change in weight-for-age z score from surgery to discharge was −1.0 with a range from −2.3 to 0.2. Delayed post-operative nutrition (p < 0.001) and reintubation following initial post-operative extubation (p = 0.001) were associated with decrease in weight-for-age z score.
Infants undergoing repair of two-ventricle congenital cardiac disease had poor growth in the post-operative period. This may be mitigated by early initiation of post-operative nutrition.
The primary objective of conservation is to preserve biodiversity. Biodiversity encompasses not only distinct life forms such as species and subspecies, but also unique adaptations such as cooperative breeding. Cooperatively breeding birds exhibit a variety of distinctive traits that render some species unusually vulnerable to, or resistant to, habitat loss, degradation, and fragmentation, and to the problems inherent to small populations. Especially relevant are extreme philopatry, sensitivity to habitat quality, and the presence of large numbers of non-breeding adults (helpers). To our knowledge, no one has previously assessed how cooperative breeders as a group are faring against the threats to their continued existence they currently face. In this chapter we conduct such an assessment and examine the interaction between the distinctive features of cooperative breeders and the various threats to biodiversity.
In the absence of a body of previous work, we take a simplistic approach and look for broad, general patterns rather than attempting complex analyses. The existing data simply will not support the latter, compelling us to propose hypotheses rather than test them. We fully recognize that, given the diverse ecologies of cooperatively breeding birds (Chapter 5), there will be numerous exceptions to any generalization made about the group. We also recognize that many generalizations will apply to some of the diverse array of cooperative breeding systems but not others, for example to systems with singular breeders assisted by natal helpers but not to systems with plural breeders.
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