Normal interstage growth after the norwood operation associated with interstage home monitoring

After stage 1 palliation (S1P) with a Norwood operation, infants commonly experience growth failure during the initial interstage period. Growth failure during this high-risk period is associated with worse outcomes. This study evaluated the growth patterns of patients enrolled in the authors' interstage home-monitoring program (HMP), which uses a multidisciplinary team approach to nutrition management. From 2000 to 2009, 148 infants were enrolled in the HMP after S1P. Families recorded daily weights during the interstage period and alerted the interstage monitoring team about protocol violations of nutritional goals. Interstage monitoring and inpatient data from the S1P hospitalization were reviewed to identify risk factors for poor growth. Growth outcomes were compared with published norms from the Centers for Disease Control. Interstage survival for patients in the HMP was 98 % (145/148). Growth velocity during the interstage period was 26 ± 8 g/day. The weight-for-age z-scores decreased from birth to discharge after S1P (-0.4 ± 0.9 to -1.3 ± 0.9; p < 0.001) but then increased during the interstage period to the time of S2P (-0.9 ± 1; p < 0.001). The factors associated with improved growth during the interstage period included male gender, greater birth weight, full oral feeding at S1P discharge, and a later birth era. After S1P, infants enrolled in an HMP experienced normal growth velocity during the interstage period. Daily observation of oxygen saturation, weight change, and enteral intake together with implementation of a multidisciplinary feeding protocol is associated with excellent interstage growth and survival.

Improvements in survival and neurodevelopmental outcomes in surgical treatment of hypoplastic left heart syndrome: a meta-analytic review

The purpose of this study was to analyze the changes over the past two decades in hospital survival and neurodevelopmental outcomes after surgical treatment for hypoplastic left heart syndrome. The hypothesis for this study is that increasing hospital survival following the Stage I Norwood (S1N) procedure is associated with improvements in neurodevelopmental outcomes. Studies included in the meta-analysis were identified by searching Ovid MEDLINE from January 1980 to October 2010. A total of 72 articles were identified. Fifteen single-center study articles were appropriate for obtaining survival data and 14 were used for neurodevelopmental outcomes. Wechsler Intelligence Test IQ scores and the Bayley II Mental Development (MDI) and Psychomotor Development Indices (PDI) were the primary neurodevelopmental outcomes included in this meta-analysis. Metaregression analysis using a mixed-effects model compared the percent survival and neurodevelopmental scores with the year of surgery. Hospital survival for the S1N operation increased significantly from 1996 to 2007 (p < .05). The overall mean survival during this time period was 80.05% (95% confidence interval [CI], 76.4-84.0%). Standardized Wechsler IQ scores increased significantly from 1989 to 1999 (p < .05) and the mean IQ was 85.09 (95% CI, 82.3-89.5). The Bayley II MDI increased significantly from 1998 to 2005 (p < .05) with a mean MDI of 86.9 (95% CI, 84.9-88.9). The Bayley II PDI increased significantly from 1998 to 2005 (p < .05) with a mean PDI of 73.4 (95% CI, 71.2-75.5). Increased survival has been associated with improved but below normal neurodevelopmental outcomes.