Growth Asymmetry, Head Circumference, and Neurodevelopmental Outcomes in Infants with Single Ventricles.
OBJECTIVE
To assess the variability in asymmetric growth and its association with neurodevelopment in infants with single ventricle (SV).


METHODS
We analyzed weight-for-age z-score minus head circumference-for-age z-score (HCAZ), relative head growth (cm/kg), along with individual growth variables in subjects prospectively enrolled in the Infant Single Ventricle Trial. Associations between growth indices and scores on the Psychomotor Developmental Index (PDI) and Mental Developmental Index (MDI) of the Bayley Scales of Infant Development-II (BSID-II) at 14 months were assessed.


RESULTS
Of the 230 subjects enrolled in the Infant Single Ventricle trial, complete growth data and BSID-II scores were available in 168 (73%). Across the cohort, indices of asymmetric growth varied widely at enrollment and before superior cavopulmonary connection (SCPC) surgery. BSID-II scores were not associated with these asymmetry indices. In bivariate analyses, greater pre-SCPC HCAZ correlated with higher MDI (r = 0.21; P = .006) and PDI (r = 0.38; P < .001) and a greater HCAZ increase from enrollment to pre-SCPC with higher PDI (r = 0.15; P = .049). In multivariable modeling, pre-SCPC HCAZ was an independent predictor of PDI (P = .03), but not MDI.


CONCLUSIONS
In infants with SV, growth asymmetry was not associated with neurodevelopment at 14 months, but pre-SCPC HCAZ was associated with PDI. Asymmetric growth, important in other high-risk infants, is not a brain-sparing adaptation in infants with SV.


BACKGROUND
Clinicaltrials.gov: NCT00113087.
Department of Pediatrics, University of Utah, Salt Lake City, UT. Electronic address: thomas.a.miller@hsc.utah.edu.
Thomas A
TA
Miller
New England Research Institute, Watertown, MA.
Victor
V
Zak
New England Research Institute, Watertown, MA.
Peter
P
Shrader
Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
Chitra
C
Ravishankar
National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD.
Victoria L
VL
Pemberton
Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA.
Jane W
JW
Newburger
Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, WI.
Amanda J
AJ
Shillingford
New England Research Institute, Watertown, MA.
Nicholas
N
Dagincourt
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
James F
JF
Cnota
Department of Surgery, University of Utah, Salt Lake City, UT.
Linda M
LM
Lambert
Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Renee
R
Sananes
Department of Pediatrics, Columbia University Medical Center, New York, NY.
Marc E
ME
Richmond
Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, New York, NY.
Daphne T
DT
Hsu
Department of Pediatrics, Duke University Medical Center, Durham, NC.
Stephen G
SG
Miller
Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
Sinai C
SC
Zyblewski
Department of Pediatrics, University of Utah, Salt Lake City, UT.
Richard V
RV
Williams
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D018376:Cardiovascular Abnormalities; D002508:Cephalometry; D004311:Double-Blind Method; D004656:Enalapril / Q000627:therapeutic use; D005260:Female; D006130:Growth Disorders / Q000209:etiology*; D006330:Heart Defects, Congenital / Q000150:complications* / Q000188:drug therapy; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D065886:Neurodevelopmental Disorders / Q000209:etiology*; D011446:Prospective Studies
D000806:Angiotensin-Converting Enzyme Inhibitors; D004656:Enalapril