Author + information
- Jeffrey B. Anderson,
- David Brown,
- Megan Horsley,
- Katherine Bates,
- Samuel Hanke,
- Stacey Lihn,
- James Tweddell and
- Carole Lannon
Background: Growth failure (GF) is common in infants with hypoplastic left heart syndrome (HLHS) and is associated with poor short term outcomes. We sought to demonstrate changes in growth failure in infants cared for at National Pediatric Quality Improvement Collaborative (NPC-QIC) sites and to demonstrate the effect of interstage GF on outcomes at stage 2 palliation.
Methods: Retrospective analysis of NPC-QIC registry data from patients at 60 different clinical sites enrolled between 2009-16. Primary outcome was interstage growth failure (GF), defined as change in weight-for-age z-score of ≤ −0.5 between stage 1 (s1P) discharge and stage 2 palliation (s2P). Statistical process control was used to assess changes in collaborative GF. Secondary outcome was length of stay following s2P. Patient and center-related factors were assessed for association with GF and longer post-operative s2P hospitalization. Appropriate classical statistical methods were used in univariable and multivariable analyses.
Results: There were 1,869 infants enrolled in the NPC-QIC registry in this period; 63% male with 92.5% surviving to s2P. Statistical process control demonstrated significant reduction in infants experiencing GF from 18% to 10%. In multivariable modeling infants who experienced interstage GF had a longer median s2P length of stay (10 days; IQR 2-80) compared to those not experiencing GF (8 days; IQR 2-187), p=0.001. Other factors independently associated with longer s2P length of stay included longer s1P length of stay (p<0.001), moderate or greater tricuspid regurgitation at s1P discharge (p<0.001) and clinical site (p<0.001). Several independent factors associated with GF were identified: concomitant presence of a non-cardiac anomaly (p=0.002), moderate or greater tricuspid regurgitation at s1P discharge (p<0.04), and longer interstage (p=0.03).
Conclusions and Implications: Through this collaborative effort, GF has improved in infants with HLHS. Infants experiencing interstage GF have longer post-operative stays following s2P. GF is more common in infants with non-cardiac anomalies, moderate or greater tricuspid regurgitation as well as those with longer interstage periods.
Moderated Poster Contributions
Congenital Heart Disease and Pulmonary Hypertension Moderated Poster Theater, Poster Hall, Hall C
Sunday, March 19, 2017, 1:00 p.m.-1:10 p.m.
Session Title: Finding Out What Works in Pediatric and Congenital Heart Disease
Abstract Category: 10. Congenital Heart Disease: Pediatric
Presentation Number: 1312M-07
- 2017 American College of Cardiology Foundation