Cardiology in the Young

Original Articles

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

Barbara Medoff-Coopera1 c1, Sharon Y. Irvinga2, Bradley S. Marinoa3, J. Felipe García-Españaa4, Chitra Ravishankara5, Geoffrey L. Birda6 and Virginia A. Stallingsa4

a1 Department of Pediatrics, The Children’s Hospital of Philadelphia and School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America

a2 School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America

a3 The Heart Institute Research Core at Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America

a4 Department of Pediatrics, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America

a5 Department of Cardiology, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America

a6 Department of Critical Care, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America

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.

(Received May 07 2010)

(Accepted September 20 2010)

(Online publication November 12 2010)

Correspondence:

c1 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

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