Cardiology in the Young

Original Articles

Poor post-operative growth in infants with two-ventricle physiology

Jeffrey B. Andersona1 c1, Bradley S. Marinoa1a2, Sharon Y. Irvinga3, J. Felipe García-Españaa4, Chitra Ravishankara4, Virginia A. Stallingsa5 and Barbara Medoff-Coopera3a6

a1 Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America

a2 Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America

a3 School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America

a4 Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America

a5 Division of Gastroenterology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America

a6 Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America

Abstract

Background 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.

Materials and methods 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.

Results 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.

Conclusions 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.

(Received December 10 2010)

(Accepted January 27 2011)

(Online publication March 09 2011)

Correspondence:

c1 Correspondence to: J. B. Anderson, MD, MPH, Division of Cardiology, Department of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 2003, Cincinnati, 45255 Ohio, United States of America. Tel: 513 636 3865; Fax: 513 636 3952; E-mail: jeffrey.anderson@cchmc.org