title: Patient and practice factors affecting growth of infants with systemic-to-pulmonary shunt.
abstract: BACKGROUND
  On recognising poor growth following neonatal palliation with a systemic-to-pulmonary shunt, we sought to determine how patient- and procedure-related factors impact growth, paying attention to the role of the primary cardiologist in this process.
  
  
  METHODS
  In a retrospective review, neonates (133 patients) receiving modified systemic-to-pulmonary artery shunts from 2002 to 2009 were studied and outpatient visits were reviewed. Patients with single- and two-ventricle circulations after shunt takedown were compared using weight-for-age z-score.
  
  
  RESULTS
  Single-ventricle patients had a higher weight-for-age z-score at neonatal surgery than two-ventricle patients (-0.4 ± 1.0 compared with -1.2 ± 0.9, with p < 0.001), but they had a greater drop in the weight-for-age z-score to the first outpatient visit (-1.1 ± 0.7 compared with -0.8 ± 0.7, with p = 0.02). After the first outpatient visit, the weight-for-age z-score was not significantly different between single-ventricle and two-ventricle patients. From multivariate analysis, a lower number of nutritional interventions by cardiologists was significantly associated with poor growth (p = 0.03). Poor growth was not associated with race, use of feeding tube, exclusive formula use, or proximity to surgical centre.
  
  
  CONCLUSIONS
  The significant drop in the weight-for-age z-score from neonatal surgery to first outpatient visit suggests that these patients may receive inadequate nutrition. The poorest performers received the least number of outpatient changes to their diet. This finding underscores the critical role of the primary cardiologist in optimising weight gain through adjustments in nutrition.
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30322-1062, United States of America.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: McCrary
authors.forename: Martha L
authors.initials: ML
authors.lastname: Clabby
authors.forename: William T
authors.initials: WT
authors.lastname: Mahle
mesh_terms: D058366:Blalock-Taussig Procedure; D001835:Body Weight; D001942:Breast Feeding / Q000706:statistics & numerical data; D002657:Child Development; D015331:Cohort Studies; D002149:Energy Intake; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006343:Heart Septal Defects / Q000601:surgery; D006345:Heart Septal Defects, Ventricular / Q000601:surgery; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery; D007223:Infant; D041943:Infant Formula / Q000706:statistics & numerical data; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D058327:Norwood Procedures; D009752:Nutritional Status; D018633:Pulmonary Atresia / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D013771:Tetralogy of Fallot / Q000601:surgery; D014188:Transposition of Great Vessels / Q000601:surgery; D016896:Treatment Outcome; D015430:Weight Gain