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New insights on growth trajectory in infants with complex congenital heart disease

      Highlights

      • We identified 4 classes of WAZ-GT in infants with cCHD.
      • The same classes were found in one and two ventricle cCHD.
      • Half of infants fell into poor WAZ-GT classes.
      • Interventions can target the predictors of poor WAZ-GT.

      Abstract

      Purpose

      We aimed to describe the weight-for-age Z-score growth trajectory (WAZ-GT) of infants with complex congenital heart disease (cCHD) after neonatal cardiac surgery in the first 4 months of life and assess potential risk factors.

      Methods

      We utilized data from a previously reported trial of the REACH telehealth home monitoring (NCT01941667) program which evaluated 178 infants with cCHD from 2012 to 2017. Over the first 4 months of life, weekly infant weights were converted to WAZ. WAZ-GT classes were identified using latent class growth modeling. Multinomial logistic regression models were used to examine the associations between potential risk factors and WAZ-GT classes.

      Results

      Four distinct classes of WAZ-GT were identified: maintaining WAZ > 0, 14%; stable around WAZ = 0, 35%; partially recovered, 28%; never recovered, 23%. Compared with reference group “stable around WAZ=0,” we identified clinical and sociodemographic determinants of class membership for the three remaining groups. “Maintaining WAZ > 0” had greater odds of having biventricular physiology, borderline appetite, and a parent with at least a college education. “Partially recovered” had greater odds of hospital length of stay>14 days and being a single child in the household. “Never recovered” had greater odds hospital length of stay >14 and > 30 days, tube feeding at discharge, and low appetite.

      Conclusions

      This study described distinct classes of WAZ-GT for infants with cCHD early in infancy and identified associated determinants.

      Practice implications

      Findings from this study can be used in the identification of infants at risk of poor WAZ-GT and in the design of interventions to target growth in this vulnerable patient population.

      Keywords

      Abbreviations:

      cCHD (complex congenital heart disease), LOS (length of stay), WAZ (weight-for-age Z-score), WAZ-GT (weight-for-age Z-score growth trajectory)
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