Abstract
Growth problems are prevalent among infants with congenital heart disease. We sought to determine whether frequency of outpatient clinic visits correlated with weight gain in patients with hypoplastic left heart syndrome or variant during the interstage period between discharge from stage I palliation and presentation for stage II palliation (SIIP). Using prospectively collected data from the JCCHD NPC-QIC database from June 2008 to July 2013, we performed a retrospective cohort study assessing the association of days between clinic visits (DBV) with the change in weight-for-age z-score (WAZ) during the interstage period. Eligible subjects were those who survived to a SIIP performed at <270 days of age and had at least two outpatient clinic visits. There were 561 patients from 49 centers who fulfilled inclusion criteria. The average interstage change in WAZ was +0.22. The mean number of DBV was 16.1 days, and the average number of clinic visits was six. There was no correlation of change in WAZ with either DBV (r = 0.02, P = 0.62) or the number of visits (r = 0.03, P = 0.44). Subjects within this cohort are seen about every 2 weeks averaged over the interstage period. There is no correlation between interstage visit frequency and change in WAZ in this patient population. Further research is needed to describe differences in visit frequency as the patient progresses through the interstage period and to elucidate whether patient factors such as growth velocity are influencing visit frequency. The optimal visit frequency remains unknown.
Similar content being viewed by others
References
Anderson JB, Beekman RH, Border WL et al (2009) Lower weight-for-age z score adversely affects hospital length of stay after the bidirectional Glenn procedure in 100 infants with a single ventricle. J Thorac Cardiovasc Surg 138(397–404):e1. doi:10.1016/j.jtcvs.2009.02.033
Anderson JB, Iyer SB, Schidlow DN et al (2012) Variation in growth of infants with a single ventricle. J Pediatr 161(16–21):e3. doi:10.1016/j.jpeds.2012.01.009
Boris JR (2011) Primary care cardiology for patients with hypoplastic left heart syndrome. Cardiol Young 21(Suppl 2):53–58. doi:10.1017/S1047951111001594
Brown DW, Connor JA, Pigula FA et al (2011) Variation in preoperative and intraoperative care for first-stage palliation of single-ventricle heart disease: a report from the joint council on congenital heart disease national quality improvement collaborative. Congenit Heart Dis 6:108–115. doi:10.1111/j.1747-0803.2011.00508.x
Feinstein JA, Benson DW, Dubin AM et al (2012) Hypoplastic left heart syndrome: current considerations and expectations. J Am Coll Cardiol 59:S1–S42. doi:10.1016/j.jacc.2011.09.022
Furck AK, Uebing A, Hansen JH et al (2010) Outcome of the Norwood operation in patients with hypoplastic left heart syndrome: a 12-year single-center survey. J Thorac Cardiovasc Surg 139:359–365. doi:10.1016/j.jtcvs.2009.07.063
Ghanayem N, Hoffman G, Mussatto K et al (2003) Home surveillance program prevents interstage mortality after the Norwood procedure. J Thorac Cardiovasc Surg 126:1367–1375. doi:10.1016/S0022-5223(03)00071-0
Ghanayem NS, Allen KR, Tabbutt S et al (2012) Interstage mortality after the Norwood procedure: results of the multicenter single ventricle reconstruction trial. J Thorac Cardiovasc Surg 144:896–906. doi:10.1016/j.jtcvs.2012.05.020
Hehir DA, Rudd N, Slicker J et al (2012) Normal interstage growth after the Norwood operation associated with interstage home monitoring. Pediatr Cardiol 33:1315–1322. doi:10.1007/s00246-012-0320-x
Horbar JD, Rogowski J, Plsek PE et al (2001) Collaborative quality improvement for neonatal intensive care. Pediatrics 107:14–22. doi:10.1542/peds.107.1.14
Kugler JD, Beekman Iii RH, Rosenthal GL et al (2009) Development of a pediatric cardiology quality improvement collaborative: from inception to implementation. From the joint council on congenital heart disease quality improvement task force. Congenit Heart Dis 4:318–328. doi:10.1111/j.1747-0803.2009.00328.x
McCrary AW, Clabby ML, Mahle WT (2013) Patient and practice factors affecting growth of infants with systemic-to-pulmonary shunt. Cardiol Young 23:499–506. doi:10.1017/S1047951112001382
Petit CJ, Fraser CD, Mattamal R et al (2011) The impact of a dedicated single-ventricle home-monitoring program on interstage somatic growth, interstage attrition, and 1-year survival. J Thorac Cardiovasc Surg 142:1358–1366. doi:10.1016/j.jtcvs.2011.04.043
Srinivasen C (2009) Standardized management improves outcomes after the Norwood procedure. Congenit Heart Dis 4:329–337
Acknowledgments
“The Joint Council on Congenital Heart Disease National Pediatric Cardiology Quality Improvement Collaborative is supported by a grant from the Cincinnati Children’s Heart Association and a cooperative agreement (HS 016957) from the Agency for Healthcare Research and Quality. The authors would like to thank Michael J. Hurst for his assistance with information technology.
Conflicts of interest
The authors declare they have no conflicts of interest.
Ethical standards
This study has received approval from the JCCHD and the data collection on human patients under the auspices of the JCCHD has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Author information
Authors and Affiliations
Corresponding author
Additional information
The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.
Rights and permissions
About this article
Cite this article
Hurst, D.M., Oster, M.E., Smith, S. et al. Is Clinic Visit Frequency Associated with Weight Gain During the Interstage Period? A Report from the Joint Council on Congenital Heart Disease National Pediatric Cardiology Quality Improvement Collaborative (JCCHD-NPCQIC). Pediatr Cardiol 36, 1382–1385 (2015). https://doi.org/10.1007/s00246-015-1169-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-015-1169-6