Amy Jo Lisanti1, Jungwon Min2, Nadya Golfenshtein3, Chitra Ravishankar4, John M Costello5, Liming Huang6, Desiree Fleck7, Barbara Medoff-Cooper8. 1. Department of Family and Community Health, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104, United States of America; Research Institute, Children's Hospital of Philadelphia, 734 Schuylkill Ave, Philadelphia, PA 19146, United States of America. Electronic address: lisanti@upenn.edu. 2. Department of Biomedical and Health informatics, Research Institute, Children's Hospital of Philadelphia, 734 Schuylkill Ave, Philadelphia, PA 19146, United States of America. 3. University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa 3498838, Israel. 4. Division of Cardiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States of America; Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States of America. 5. Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, 135 Rutledge Avenue, MSC 56, Charleston, SC 29425, United States of America. 6. Office of Nursing Research, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104, United States of America. 7. Department of Behavioral Health Sciences, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104, United States of America. 8. Department of Family and Community Health, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104, United States of America; Research Institute, Children's Hospital of Philadelphia, 734 Schuylkill Ave, Philadelphia, PA 19146, United States of America.
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.
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.
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