Pattern of head circumference growth following bidirectional Glenn in infants with single ventricle heart disease

2020 ◽  
pp. 1-8
Author(s):  
Stephanie Y Tseng ◽  
Julia Anixt ◽  
Jareen Meinzen-Derr ◽  
Cameron Thomas ◽  
David S Cooper ◽  
...  
Keyword(s):  
Heart Disease ◽  
Motor Development ◽  
Head Circumference ◽  
Single Ventricle ◽  
Developmental Outcomes ◽  
Z Score ◽  
Head Growth ◽  
Bidirectional Glenn ◽  
Post Surgery ◽  
Developmental Index

Abstract Background: Infants with single ventricle congenital heart disease demonstrate increasing head growth after bidirectional Glenn; however, the expected growth trajectory has not been well described. Aims: 1) We will describe the pattern of head circumference growth in the first year after bidirectional Glenn. 2) We will determine if head growth correlates with motor developmental outcomes approximately 12 months after bidirectional Glenn. Methods: Sixty-nine single ventricle patients underwent bidirectional Glenn between 2010 and 2016. Patients with structural brain abnormalities, grade III–IV intra-ventricular haemorrhage, significant stroke, or obstructive hydrocephalus were excluded. Head circumference and body weight measurements from clinical encounters were evaluated. Motor development was measured with Psychomotor Developmental Index of the Bayley Scales of Infant Development, Third Edition. Generalised estimating equations assessed change in head circumference z-scores from baseline (time of bidirectional Glenn) to 12 months post-surgery. Results: Mean age at bidirectional Glenn was 4.7 (2.3) months and mean head circumference z-score based on population-normed data was −1.13 (95% CI −1.63, −0.63). Head circumference z-score increased to 0.35 (95% CI −0.20, 0.90) (p < 0.0001) 12 months post-surgery. Accelerated head growth, defined as an increase in z-score of >1 from baseline to 12 months post-surgery, was present in 46/69 (66.7%) patients. There was no difference in motor Psychomotor Developmental Index scores between patients with and without accelerated head growth. Conclusion: Single ventricle patients demonstrated a significant increase in head circumference after bidirectional Glenn until 10–12 months post-surgery, at which time growth stabilised. Accelerated head growth did not predict sub-sequent motor developmental outcomes.

Abstract 17071: Growth Asymmetry, Head Circumference and Neurodevelopmental Outcomes in Infants with Single Ventricles

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Thomas A Miller ◽  
Victor Zak ◽  
Peter Shrader ◽  
Chitra Ravishankar ◽  
Victoria L Pemberton ◽  
...  
Keyword(s):  
Gestational Age ◽  
Head Circumference ◽  
Single Ventricle ◽  
Univariate Analysis ◽  
Somatic Growth ◽  
Z Score ◽  
Neurodevelopmental Outcomes ◽  
Head Growth ◽  
Developmental Index ◽  
Asymmetric Growth

Poor somatic growth is common in infants with single ventricle (SV) physiology and has been linked to increased morbidity and impaired neurodevelopment. Asymmetry in somatic growth, a potential brain-sparing adaptation, is important in predicting outcomes in premature and small for gestational age (SGA) infants. Objectives: To assess variability in growth asymmetry and its associations with neurodevelopment in infants with SV. Methods: We analyzed growth asymmetry (weight for age z-score (WAZ) minus head circumference for age z-score (HCAZ)), relative head growth (change in cm/change in kg), HCAZ, and change in HCAZ from baseline to pre-Glenn in subjects prospectively enrolled in the Pediatric Heart Network Infant Single Ventricle (ISV) trial. Associations between these indices and results of the Psychomotor Developmental Index (PDI) and Mental Developmental Index (MDI) of the Bayley Scales of Infant Development-II (BSID) at 14 months were assessed. Results: Of the 230 patients enrolled in ISV, complete biometric data and BSID results were available in 168 (73%). For this cohort, age at enrollment was 21±9 days, age at pre-Glenn was 167±52 days, gestational age was 38.3±1.4 weeks, and 71% were male. Growth asymmetry varied across the cohort at enrollment (0.43 ±1.02, range -2.85 to 4.84) and the pre-Glenn visit (-0.23 ±1.21, range -4.45 to 3.00) as did the relative head growth (2.40±0.86, range 0.50 to 8.00). BSID scores were not associated with indices of growth asymmetry. In univariate analysis, larger pre-Glenn HCAZ correlated with higher MDI (r=0.21, p=0.006) and PDI (r=0.38, p<0.001) and greater increase in HCAZ from enrollment to pre-Glenn was associated with higher PDI (r=0.15, p=0.049). In multivariable modeling adjusting for site, serious adverse events, stage 1 length of stay, and height at 14 months, pre-Glenn HCAZ was an independent predictor of PDI (p=0.03), but not MDI. For each one unit Z-score increase in pre-Glenn HCAZ, the predicted PDI score increased by 2.5 points. Conclusions: In infants with SV, BSID scores were associated with pre-Glenn HCAZ but not with the degree of asymmetric growth. Future studies should explore why asymmetric growth that seems important in premature and SGA infants appears less relevant in infants with SV.

scholarly journals Head circumference trajectory in children with perinatal stroke

2021 ◽  
pp. 088307382199610
Author(s):  
Amanda Leong ◽  
Amalia Floer ◽  
Adam Kirton ◽  
Aleksandra Mineyko
Keyword(s):  
Ischemic Stroke ◽  
Head Circumference ◽  
Developmental Outcomes ◽  
Normal Growth ◽  
Fisher Exact Test ◽  
Arterial Ischemic Stroke ◽  
Neurodevelopmental Outcomes ◽  
Perinatal Stroke ◽  
Head Growth ◽  
Poor Outcome

Background: Perinatal stroke is a leading cause of hemiparetic cerebral palsy and lifelong disability. Neurodevelopmental outcomes are difficult to predict and markers of long-term poor outcome continue to be investigated. Deceleration in growth of head circumference has been associated with worse developmental outcomes in neonatal brain injury. We hypothesized that perinatal stroke would result in decreased rates of head growth during childhood that would be associated with worse developmental outcomes. Methods: Patients with magnetic resonance imaging (MRI)–confirmed neonatal arterial ischemic stroke and arterial presumed perinatal ischemic stroke were identified from a population-based research cohort (Alberta Perinatal Stroke Project). Demographics and occipital-frontal circumference data were collected from medical records. Head growth was compared to typically developing control charts using a 2-tailed t test. The Fisher exact test was used to examine associations between Pediatric Stroke Outcome Measures (PSOM) scores and occipital-frontal head circumference. Results: Three hundred fifteen occipital-frontal head circumference measurements were collected from 102 patients (48 female, 54 male), over a median of 3.2 years (standard deviation = 5.18, range = 0-18.3). After 3 months for female patients and 1 year for male patients, occipital-frontal head circumference deviated and remained below normal growth trajectories ( P < .05) with a large effect size (Cohen d >0.8). Poor outcome (PSOM ≥ 1) was associated with smaller occipital-frontal head circumference ( P < .05). Conclusion: Head growth deceleration is observed in children with perinatal arterial ischemic stroke and is associated with poor outcome. Head circumference may be a tool to alert clinicians to the potential of abnormal neurologic outcome.

Superior Vena Cava Banding to Facilitate Unilateral Bidirectional Glenn Operation in Patients With Single Ventricle Heart Disease and Bilateral Superior Caval Veins

2016 ◽  
Vol 8 (2) ◽  
pp. 215-219 ◽  
Author(s):  
Matthew C. Schwartz ◽  
David Nykanen ◽  
William DeCampli ◽  
Kamal Pourmoghadam
Keyword(s):  
Heart Disease ◽  
Congenital Heart ◽  
Single Ventricle ◽  
Superior Vena ◽  
Vena Cava ◽  
Novel Technique ◽  
Bidirectional Glenn ◽  
Increased Risk ◽  
Bridging Vein ◽  
Cavopulmonary Connection

Staged palliation to achieve a total cavopulmonary connection is a common treatment strategy in patients with single ventricle congenital heart disease. Patients with bilateral superior caval veins (bilateral SVC) often require the creation of bilateral superior cavopulmonary connections as part of the staged palliation, and these patients are at increased risk of morbidity. We describe a novel technique used in two patients with bilateral SVC and very small (1-2 mm) bridging vein that encouraged bridging vein growth and facilitated creation of a unilateral superior cavopulmonary connection.

Growth of children with a functionally single ventricle following palliation at moderately increased altitude

2000 ◽  
Vol 10 (3) ◽  
pp. 193-200 ◽  
Author(s):  
Ronald W. Day ◽  
David M. Denton ◽  
W. Daniel Jackson
Keyword(s):  
Single Ventricle ◽  
Fontan Procedure ◽  
Response To Therapy ◽  
Z Score ◽  
Bidirectional Glenn ◽  
Rate Of Growth ◽  
Z Scores ◽  
Bidirectional Glenn Procedure ◽  
Glenn Procedure

AbstractThe bidirectional Glenn and Fontan procedures are empirically performed as interim and definitive procedures in children with a functionally single ventricle. The optimal stage of palliation, nonetheless, remains unknown. During childhood, growth is a fundamental measure of response to therapy. Growth may be influenced by the degree of cyanosis, the volume load on the ventricle, and cardiac performance. Thus, the weight and stature of children with a functionally single ventricle who underwent a bidirectional Glenn procedure or a Fontan procedure were studied to determine the effect of each intervention on growth. Z scores for weight and stature were retrospectively determined prior to palliation, at yearly intervals for 4 years, and from long-term measurements until 18 years of age in all patients with at least 2 years of observation following palliation. Growth was evaluated in 54 patients with a bidirectional Glenn procedure, and 65 patients with a Fontan procedure. The Z scores for weight were improved after each method of surgical palliation. Stature, however, was improved only following the bidirectional Glenn procedure. Growth was impaired in patients who developed protein losing enteropathy. Weight improved only during the initial 2 years after the Fontan procedure in patients who had a surgical fenestration. Over the long-term, patients who underwent a Fontan procedure were more likely to have a Z score less than −2.0 for weight and stature than patients who underwent only a bidirectional Glenn procedure. Late mortality and the incidence of heart transplantation were increased in patients who experienced a decrease in their rate of growth, defined as a negative change of more than one Z score in weight or stature, following the Fontan procedure. In conclusion, at moderately increased altitude, children with a functionally single ventricle grow more appropriately following the bidirectional Glenn procedure than following the Fontan procedure. A decrease in the rate of growth is associated with a poor prognosis following the Fontan procedure.

Abstract 13454: Relationship Between Brain-type Natriuretic Peptide and Serum Growth Factors in Infants With Single Ventricle Heart Disease and Shunt- or Ductal-dependent Pulmonary Blood Flow

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Monique M Gardner ◽  
Jen Faerber ◽  
Tamar J Preminger ◽  
Catherine M Avitabile ◽  
Somya Shankar ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Growth Factors ◽  
Pilot Study ◽  
Growth Factor ◽  
Single Ventricle ◽  
Z Score ◽  
Failure State ◽  
The Relationship ◽  
Over Time

Introduction: For infants with shunt- or ductal-dependent single-ventricle heart disease (SD-SVHD), poor growth is common and associated with morbidity and impaired neurodevelopmental outcome. While attention has focused on nutrition to promote weight gain, little is known about the contribution of heart failure to diminished growth. Methods: A prospective observational pilot study was performed to assess the relationship between heart failure, assessed by brain natriuretic peptide (BNP), and growth factors [insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 3 (IGFBP-3)] at 4 visits: 1) prior to discharge from neonatal intervention, 2) immediately prior to stage 2 palliation, 3) prior to discharge after stage 2 palliation, and 4) 3-6 months after stage 2 discharge. IGF-1 Z-scores were generated by the analysis lab using reference data. The relationship between log-transformed BNP and growth factors was analyzed using pairwise correlations at each visit and modeled over time with a linear mixed-effects model. Correlations were considered statistically significant using a p-value <0.10, given the exploratory nature of the study. Results: The study included 38 infants (66% male, 68% hypoplastic left heart syndrome). Median BNP was elevated at Visit 1 and decreased over time [287 pg/dL (IQR 147, 794), 85 pg/dL (52, 183), 90 pg/dL (70, 138), and 47 pg/dL (43, 135)]. Median IGF Z-score was <0 at each visit but increased over time [-0.9 (IQR -1.1, 0.1), -0.7 (-1.2, 0.1), -0.5 (-1.2, 0), and -0.2 (-0.8, 0)]. Inverse correlations were noted between log BNP and IGF-1 Z-score at Visit 1 (r = -0.45, p=0.06) and Visit 3 (r = -0.50, p=0.02), and between log BNP and IFGBP-3 at Visit 1 (r = -0.44, p=0.06) and Visit 2 (r = -0.34, p=0.08). There was a small effect of log BNP on IGF-1 Z-score over all time periods (coefficient: -0.23, 95% CI: -0.49, 0.024, p=0.07). Conclusions: This pilot study demonstrates an inverse correlation between BNP and growth factors, suggesting that the heart failure state associated with this physiology may play a mechanistic role in impaired growth. Further work directed at therapies that target the underlying heart failure state might help to optimize the potential for growth in this vulnerable patient population.

scholarly journals Echocardiographic Evaluation Before Bidirectional Glenn Operation in Functional Single-Ventricle Heart Disease

2011 ◽  
Vol 4 (5) ◽  
pp. 498-505 ◽  
Author(s):  
Kenan W.D. Stern ◽  
Doff B. McElhinney ◽  
Kimberlee Gauvreau ◽  
Tal Geva ◽  
David W. Brown
Keyword(s):  
Heart Disease ◽  
Single Ventricle ◽  
Bidirectional Glenn ◽  
Echocardiographic Evaluation

scholarly journals Developmental Outcomes of Very Low Birth Weight Infants with Catch-up Head Growth: A Nationwide Cohort Study

2021 ◽  
Author(s):  
You Mi Hong ◽  
Dong Hue Cho ◽  
Jin Kyu Kim
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Premature Infants ◽  
Head Circumference ◽  
Very Low Birth Weight ◽  
Developmental Outcomes ◽  
Clinical Factors ◽  
Vlbw Infants ◽  
Head Growth ◽  
Catch Up

Abstract This study aims to determine demographic or perinatal characteristics in premature infant according to head growth, identify clinical factors affecting growth catch-up, and find differences in developmental outcomes according to catch-up states based on Korean Neonatal Network (KNN) data. This nationwide prospective cohort study of Korean Neonatal Network (KNN) data analyzed premature infants with very low birth weight (< 1,500 g) between 2014 and 2017. A total of 253 eligible infants who had completed Bayley scales of infant and toddler development (BSID) 3rd were assigned into two groups: a catch-up (CU) group with head circumference above the 10th percentile and a no catch-up (NCU) group with head circumference below the 10th percentile at 18-24 months of corrected age (CA). Most (81.4%, 203/253) premature infants exhibited catch-up growth at 18-24 months of CA. Rates of microcephaly, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), sepsis, necrotizing enterocolitis (NEC), length of NICU stay, ventilation care, and parenteral nutrition were significantly greater in the NCU group (P < 0.05). On multiple linear regression analysis, the BPD status was the most clinical factor affecting catch-up head growth after adjusting for gestational age, birth weight, and birth head circumference (adjusted OR 4.586, 95% CI 1.960-10.729)At 18-24 months of CA, the NCU group exhibited lower developmental indices and higher rate of developmental delay than the CU group. Motor developmental delay was the most significant factor relevant to catch-up head growth and the motor development index difference between the two groups was only statistically significant after adjusting for four major neonatal morbidities: IVH, BPD, sepsis, and NEC status (adjusted OR 10.727, 95% CI 1.922-59.868). Thus, the developmental outcome of very low birth weight (VLBW) infants at 18-24 months of CA might be dependent on whether head growth was caught up. Key clinical factors determining the catch-up status were BPD and NEC status, length of parenteral nutrition, and ventilator care. Thus, measurements of head circumference at 18-24 months of CA can predict developmental delays of VLBW infants.

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