title: Longitudinal assessment of growth in hypoplastic left heart syndrome: results from the single ventricle reconstruction trial.
abstract: BACKGROUND
  We sought to characterize growth between birth and age 3 years in infants with hypoplastic left heart syndrome who underwent the Norwood procedure.
  
  
  RESULTS
  We performed a secondary analysis using the Single Ventricle Reconstruction Trial database after excluding patients <37 weeks gestation (N=498). We determined length-for-age z score (LAZ) and weight-for-age z score (WAZ) at birth and age 3 years and change in WAZ over 4 clinically relevant time periods. We identified correlates of change in WAZ and LAZ using multivariable linear regression with bootstrapping. Mean WAZ and LAZ were below average relative to the general population at birth (P<0.001, P=0.05, respectively) and age 3 years (P<0.001 each). The largest decrease in WAZ occurred between birth and Norwood discharge; the greatest gain occurred between stage II and 14 months. At age 3 years, WAZ and LAZ were <-2 in 6% and 18%, respectively. Factors associated with change in WAZ differed among time periods. Shunt type was associated with change in WAZ only in the Norwood discharge to stage II period; subjects with a Blalock-Taussig shunt had a greater decline in WAZ than those with a right ventricle-pulmonary artery shunt (P=0.002).
  
  
  CONCLUSIONS
  WAZ changed over time and the predictors of change in WAZ varied among time periods. By age 3 years, subjects remained small and three times as many children were short as were underweight (>2 SD below normal). Failure to find consistent risk factors supports the strategy of tailoring nutritional therapies to patient- and stage-specific targets.
  
  
  BACKGROUND
  http://clinicaltrials.gov/. Unique identifier: NCT00115934.
authors: Department of Surgery, University of Utah, Salt Lake City, UT (P.T.B., L.M.L.).
authors: Phillip T
authors: PT
authors: Burch
authors: New England Research Institutes, Watertown, MA (E.G., L.A.S.).
authors: Eric
authors: E
authors: Gerstenberger
authors: The Children's Hospital of Philadelphia, Philadelphia, PA (C.R.).
authors: Chitra
authors: C
authors: Ravishankar
authors: The Children's Hospital of Wisconsin, Milwaukee, WI (D.A.H.).
authors: David A
authors: DA
authors: Hehir
authors: Nemours/A.I. DuPont Hospital for Children, Wilmington, DE (R.R.D.).
authors: Ryan R
authors: RR
authors: Davies
authors: Children's Hospital Boston and Harvard Medical School, Boston, MA (S.D.C., J.W.N., C.D.M.).
authors: Steven D
authors: SD
authors: Colan
authors: New England Research Institutes, Watertown, MA (E.G., L.A.S.).
authors: Lynn A
authors: LA
authors: Sleeper
authors: Children's Hospital Boston and Harvard Medical School, Boston, MA (S.D.C., J.W.N., C.D.M.).
authors: Jane W
authors: JW
authors: Newburger
authors: The Hospital for Sick Children, Toronto, Ontario, Canada (M.L.C., S.K.).
authors: Martha L
authors: ML
authors: Clabby
authors: Columbia University Medical Center, New York, NY (I.A.W.).
authors: Ismee A
authors: IA
authors: Williams
authors: Duke University Medical Center, Durham, NC (J.S.L.).
authors: Jennifer S
authors: JS
authors: Li
authors: University of Michigan Medical School, Ann Arbor, MI (K.U.).
authors: Karen
authors: K
authors: Uzark
authors: University of Cincinnati, Cincinnati, OH (D.S.C., J.B.A.).
authors: David S
authors: DS
authors: Cooper
authors: Department of Surgery, University of Utah, Salt Lake City, UT (P.T.B., L.M.L.).
authors: Linda M
authors: LM
authors: Lambert
authors: National Institutes of Health, Bethesda, MD (V.L.P.).
authors: Victoria L
authors: VL
authors: Pemberton
authors: University of California Los Angeles, Los Angeles, CA (N.A.P.).
authors: Nancy A
authors: NA
authors: Pike
authors: University of Cincinnati, Cincinnati, OH (D.S.C., J.B.A.).
authors: Jeffrey B
authors: JB
authors: Anderson
authors: Children's Hospital Boston and Harvard Medical School, Boston, MA (S.D.C., J.W.N., C.D.M.).
authors: Carolyn
authors: C
authors: Dunbar-Masterson
authors: The Hospital for Sick Children, Toronto, Ontario, Canada (M.L.C., S.K.).
authors: Svetlana
authors: S
authors: Khaikin
authors: Medical University of South Carolina, Charleston, SC (S.C.Z.).
authors: Sinai C
authors: SC
authors: Zyblewski
authors: Department of Pediatrics, University of Utah, Salt Lake City, UT (L.A.M.).
authors: L LuAnn
authors: LL
authors: Minich
mesh_terms: D000367:Age Factors; D001827:Body Height; D002657:Child Development / Q000502:physiology; D002675:Child, Preschool; D005260:Female; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000503:physiopathology / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D058327:Norwood Procedures / Q000379:methods*; D016896:Treatment Outcome; D015430:Weight Gain
keywords: growth; hypoplastic left heart syndrome; pediatrics; risk factors