title: Site of interstage outpatient care and growth after the Norwood operation.
abstract: BACKGROUND
  Recent efforts have focused on optimising interstage outcomes, including growth, for infants following the Norwood operation. The impact of the site of interstage care remains unclear, and it has been hypothesised that care at the surgical site may be beneficial due to greater access to resources such as nutritional support. This study evaluated the relationship between site of interstage care and weight gain in a large multicentre cohort.
  
  
  METHODS
  Infants enrolled in the National Paediatric Cardiology Quality Improvement Collaborative (2008-2013) surviving up to Stage 2 were included. Change in weight-for-age z-score between Norwood discharge and Stage 2 admission was compared in those receiving care at the surgical versus non-surgical site.
  
  
  RESULTS
  Of the 487 interstage survivors, 60% received all care at the surgical site, and 40% received care at a non-surgical site. There was no significant difference between groups in change in weight-for-age z-score: +0.36±0.96 for the surgical site group versus +0.46±1.02 for the non-surgical site group, p=0.3. Results were unchanged in multivariable analysis adjusting for differences in important baseline characteristics, duration of interstage, and home surveillance strategy. The proportion of all patients with weight-for-age z-score <-2 decreased from 40% at Norwood discharge to 29% at Stage 2, with no significant difference in change between the two groups (p=0.1).
  
  
  CONCLUSIONS
  The site of interstage care was not associated with weight gain during the interstage period. Nearly one-third of patients overall had a weight-for-age z-score <-2 at Stage 2. Further study is required to identify methods to optimise weight gain in these patients.
authors.affiliation: 1Division of Pediatric Cardiology,Department of Pediatrics and Communicable Diseases,University of Michigan,C. S. Mott Children's Hospital,Ann Arbor,MI,United States of America.
authors.forename: Mehul D
authors.identifier: http://orcid.org/0000-0002-4654-5933
authors.initials: MD
authors.lastname: Patel
authors.affiliation: 1Division of Pediatric Cardiology,Department of Pediatrics and Communicable Diseases,University of Michigan,C. S. Mott Children's Hospital,Ann Arbor,MI,United States of America.
authors.forename: Karen
authors.initials: K
authors.lastname: Uzark
authors.affiliation: 1Division of Pediatric Cardiology,Department of Pediatrics and Communicable Diseases,University of Michigan,C. S. Mott Children's Hospital,Ann Arbor,MI,United States of America.
authors.forename: Sunkyung
authors.initials: S
authors.lastname: Yu
authors.affiliation: 1Division of Pediatric Cardiology,Department of Pediatrics and Communicable Diseases,University of Michigan,C. S. Mott Children's Hospital,Ann Arbor,MI,United States of America.
authors.forename: Janet
authors.initials: J
authors.lastname: Donohue
authors.affiliation: 1Division of Pediatric Cardiology,Department of Pediatrics and Communicable Diseases,University of Michigan,C. S. Mott Children's Hospital,Ann Arbor,MI,United States of America.
authors.forename: Sara K
authors.initials: SK
authors.lastname: Pasquali
authors.affiliation: 2Department of Cardiology,Boston Children's Hospital,Boston,MA,United States of America.
authors.forename: David
authors.initials: D
authors.lastname: Schidlow
authors.affiliation: 2Department of Cardiology,Boston Children's Hospital,Boston,MA,United States of America.
authors.forename: David W
authors.initials: DW
authors.lastname: Brown
authors.affiliation: 1Division of Pediatric Cardiology,Department of Pediatrics and Communicable Diseases,University of Michigan,C. S. Mott Children's Hospital,Ann Arbor,MI,United States of America.
authors.forename: Sarah
authors.initials: S
authors.lastname: Gelehrter
mesh_terms: D000553:Ambulatory Care / Q000592:standards*; D005260:Female; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D058327:Norwood Procedures / Q000379:methods*; D018529:Nutritional Support / Q000379:methods*; D010351:Patient Discharge; D058996:Quality Improvement; D012189:Retrospective Studies; D015430:Weight Gain / Q000502:physiology*
keywords: CHD; Hypoplastic left heart syndrome; Norwood; interstage; quality improvement