• Congenital heart disease · Nov 2010

    Impact of staged palliation on somatic growth in patients with hypoplastic left heart syndrome.

    • Chandra Srinivasan, Robert D B Jaquiss, W Robert Morrow, Elizabeth A Frazier, Deeann Martin, Michiaki Imamura, and Ritu Sachdeva.
    • Division of Pediatric Cardiology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Ark, USA. csriniva@bcm.edu
    • Congenit Heart Dis. 2010 Nov 1;5(6):546-51.

    BackgroundSomatic growth pattern in infants undergoing staged palliation for hypoplastic left heart syndrome (Norwood procedure [NP], stage 2 palliation [S2P], and Fontan procedure [FP]) during transition toward a more energy efficient series circulation is not well understood.ObjectivesWe sought to determine growth pattern in these infants and factors influencing it.MethodsPatients who underwent NP since 2001 and survived at least 1 year after S2P were followed until FP or death/heart transplantation (n = 46). Weight for age z-scores (WAZ) were measured prior to NP; at initial discharge; prior to S2P; at four time periods after S2P; and prior to FP. Impact of gender, race, era of NP, anatomic subtype, NP shunt type, gastrostomy, home-surveillance program (daily weights and pulse oximetry), and interstage oxygen saturation on WAZ was evaluated.ResultsRepeated measures anova showed a significant change in WAZ across time periods (P < 0.0005), with a significant decline from Pre-NP to Pre-S2P (P < 0.0005) and steady increase from Pre-S2P to Pre-FP (P= 0.016). None of the factors evaluated had a significant effect on this growth pattern. Length of hospital stay after NP was negatively correlated with WAZ at discharge (P= 0.001), but not for other time periods. Intervals from discharge to S2P and NP to S2P interval did not correlate with WAZ.ConclusionSomatic growth is significantly impaired after NP but recovers steadily following S2P, as the patient transitions toward separated series circulation. Earlier S2P may lead to earlier resumption of normal growth in this critical period of early infancy.© 2010 Copyright the Authors. Congenital Heart Disease © 2010 Wiley Periodicals, Inc.

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