title: Genetic factors are important determinants of impaired growth after infant cardiac surgery.
abstract: OBJECTIVE
  We sought to estimate the prevalence and identify the predictors of impaired growth after infant cardiac surgery.
  
  
  METHODS
  We performed a secondary analysis of a prospective study of the role of apolipoprotein E gene polymorphisms on neurodevelopment in young children after infant cardiac surgery. Prevalence estimates for growth velocity were derived by using anthropometric measures (weight and head circumference) obtained at birth and at 4 years of age. Genetic evaluation was also performed. Growth measure z scores were calculated by using World Health Organization Child Growth Standards. Growth velocity was evaluated by using 2 different techniques: first by clustering the children into one of 3 growth velocity subgroups based on z scores (impaired growth, difference < -0.5 standard deviation; stable growth, difference of -0.5 to 0.5 standard deviation; and improving growth, difference > 0.5 SD) and second by using continuous difference scores. Statistical analyses were conducted with a combination of proportional odds models for the ordered categories and simple linear regression for the continuous outcomes.
  
  
  RESULTS
  Three hundred nineteen full-term subjects had complete anthropometric measures for weight and head circumference at birth and 4 years. The cohort was 56% male. Genetic examinations were available for 97% (309/319) of the cohort (normal, 74%; definite or suspected genetic abnormality, 26%). Frequency counts for weight categories were as follows: impaired growth, 37%; stable growth, 31%; and improving growth, 32%. Frequency counts for head circumference categories were as follows: impaired growth, 39%; stable growth, 28%; and improving growth, 33%. The presence of a definite or suspected genetic syndrome (P = .04) was found to be a predictor of impaired growth for weight but not for head circumference. When growth z scores were used as continuous outcomes, the apolipoprotein E epsilon2 allele was found to be predictive of lower z scores for both weight (P = .02) and head circumference (P = .03).
  
  
  CONCLUSIONS
  Impaired growth for both weight and head circumference is common (both >30%) in this cohort of children after infant cardiac surgery. Both the apolipoprotein E epsilon2 allele and the presence of a definite or suspected genetic syndrome were associated with impaired weight growth velocity. The apolipoprotein E epsilon2 allele was also associated with impaired growth velocity for head circumference. Persistent poor growth might have long-term implications for the health and development of children with congenital heart defects.
authors.affiliation: Division of Cardiothoracic Surgery, Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. burnhamn@email.chop.edu
authors.forename: Nancy
authors.initials: N
authors.lastname: Burnham
authors.forename: Richard F
authors.initials: RF
authors.lastname: Ittenbach
authors.forename: Virginia A
authors.initials: VA
authors.lastname: Stallings
authors.forename: Marsha
authors.initials: M
authors.lastname: Gerdes
authors.forename: Elaine
authors.initials: E
authors.lastname: Zackai
authors.forename: Judy
authors.initials: J
authors.lastname: Bernbaum
authors.forename: Robert R
authors.initials: RR
authors.lastname: Clancy
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
mesh_terms: D000367:Age Factors; D053329:Apolipoprotein E2 / Q000235:genetics*; D001835:Body Weight / Q000235:genetics*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002508:Cephalometry; D002657:Child Development; D002675:Child, Preschool; D005260:Female; D005787:Gene Frequency; D020022:Genetic Predisposition to Disease; D006130:Growth Disorders / Q000235:genetics* / Q000503:physiopathology / Q000517:prevention & control; D006257:Head / Q000254:growth & development*; D006330:Heart Defects, Congenital / Q000235:genetics / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D016017:Odds Ratio; D011110:Polymorphism, Genetic; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D053329:Apolipoprotein E2
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