Predictors of poor weight gain in infants with a single ventricle.

OBJECTIVE: To assess growth from the time of neonatal discharge to the time of performance of the bidirectional Glenn (BDG) procedure in infants with a single ventricle and determine predictors of poor growth. STUDY DESIGN: We performed a retrospective case series of infants who underwent the BDG procedure at our institution between January 2001 and December 2007 (n=102). Anthropometric and clinical data were recorded during neonatal hospitalization and before BDG. Outcome variables included weight-for-age z-score (WAZ) at the time of BDG and average daily weight gain between neonatal discharge and BDG. RESULTS: Median age at the time of BDG was 5.1 months (range, 2.4-10 months), and median WAZ was -0.4 (range, -2.6 to 3.2) at neonatal admission and -1.3 (range, -3.9 to 0.6) at the time of BDG. Non-Caucasian infants (P=.03) and those with lower WAZ at neonatal discharge (P<.0001) had a lower WAZ at BDG. Being formula-fed at neonatal discharge (P=.04), and having higher mean pulmonary arterial pressure (P=.04) and systemic oxygen saturation (P=.006) were associated with lower average daily weight gain between neonatal discharge and BDG. CONCLUSIONS: Infants with a single ventricle have poor weight gain between neonatal discharge and BDG. Non-Caucasian infants and those with evidence of increased pulmonary blood flow are at particular risk for growth failure.

Low weight-for-age z-score and infection risk after the Fontan procedure.

BACKGROUND: Poor growth is common in infants with a single ventricle. Lower weight-for-age z-score (WAZ) is associated with worse short-term outcome after bidirectional Glenn procedure. We sought to assess growth status at the time of the Fontan procedure and the effect of poor growth status on surgical outcomes. METHODS: This retrospective case series examined children who underwent Fontan at our institution between January 2003 and December 2008. Weight and height were obtained at the time of admission for Fontan. Data from preoperative echocardiogram and cardiac catheterization were abstracted to document cardiac function and hemodynamic measurements. Outcome variables included ventilator time, chest tube duration, postoperative infections (bacteremia, mediastinitis, urinary tract infection, gastroenteritis, or culture-positive pneumonia), and length of hospital stay. RESULTS: Fifty-five patients were included for analysis. The median age at Fontan was 46 months (range, 18 to 72); median WAZ was -1.0 (-3.8 to +2.0), and height for age z-score was -1.1 (-3.7 to +1.5). The WAZ was less than -2.0 in 19% of patients. Multivariable modeling revealed that patients with a WAZ less than -2.0 (p=0.006) had a greater incidence of serious postoperative infections. The only factor predicting longer length of hospital stay was presence of a serious postoperative infection (p<0.0001). Ventilator time was predicted only by length of cardiopulmonary bypass (p=0.01). No factors were associated with longer chest tube duration. CONCLUSIONS: Growth failure in children with a single ventricle persists through presentation for Fontan. A WAZ less than -2.0 at Fontan is associated with a higher rate of serious postoperative infections, which are associated with longer length of hospital stay.