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Pediatric Cardiology

, Volume 38, Issue 7, pp 1505–1514 | Cite as

Hemoglobin Level at Stage 1 Discharge has No Impact on Inter-stage Growth and Stability in Single Ventricle Infants

  • Claudia Delgado-Corcoran
  • Deborah U. Frank
  • Stephanie Bodily
  • Chong Zhang
  • Katherine H. Wolpert
  • Kathryn Lucas
  • Theodore J. Pysher
  • Angela P. Presson
  • Susan L. Bratton
Original Article

Abstract

Hemoglobin levels (Hgb) of infants with a single ventricle (SV) are traditionally maintained high to maximize oxygen-carrying capacity during stage 1 palliation (S1P), stage 2 palliation (S2P), and between stages (IS). A single-center observational cohort study was performed to determine if red blood cell transfusion during the convalescent phase of the S1P (late S1P transfusion) to achieve higher Hgb is associated with benefits during the IS including improved growth and decreased acute medical events. 137 infants <1 year with SV with SIP undergoing care from January 2008 to June 2015 were retrospectively evaluated. 78 (57%) infants received a late S1P transfusion. Median Hgb at S1P discharge was 15.9 g/dL (IQR 14.7–17.1) and median Hgb S2P at admission was 15.3 g/dL (IQR 14–16.3). Median daily weight gain was 22 g/day during IS (IQR 17–26) and median daily length gain was 0.09 cm (IQR 0.06–0.11). Hgb at SIP discharge was not associated with IS growth or fewer IS acute events. However, late S1P transfusions were associated with illness severity at S1P and more complicated S1P care. Our data suggest that SV infants after S1P, who are steadily recovering, do not benefit from late transfusion to raise their hemoglobin level at discharge.

Keywords

Hemoglobin levels Stage 1 and 2 palliation Single ventricle physiology Inter-stage period Weight and length gain Inter-stage acute event 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest to disclose.

References

  1. 1.
    Stainsby D, Jones H, Wells AW et al (2008) Adverse outcomes of blood transfusion in children: analysis of UK reports to the serious hazards of transfusion scheme 1996–2005. Brit J Haematol 141:73–79CrossRefGoogle Scholar
  2. 2.
    Kuo J, Maher K, Kirshgbom P et al (2011) Red blood cell transfusion for infants with single-ventricle physiology. Pediatric Cardiol 32:461–468CrossRefGoogle Scholar
  3. 3.
    R Core Team (2014). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna. http://www.R-project.org/
  4. 4.
    Secher EL, Stensballe J, Afshari A (2013) Transfusion in critically ill children: an ongoing dilemma. Acta Anaesthesiol Scand 57:684–691CrossRefPubMedGoogle Scholar
  5. 5.
    Blackwood J, Ar Joffe, Robertson CM et al (2010) Association of hemoglobin and transfusion with outcome after operations for hypoplastic left heart. Ann Thorac Surg 89:1378–1384CrossRefPubMedGoogle Scholar
  6. 6.
    Salvin JW, Scheeurer MA, Laussen PC et al (2011) Blood transfusion after pediatric cardiac surgery is associated with prolonged hospital stay. Ann Thorac Surg 91:204–210CrossRefPubMedGoogle Scholar
  7. 7.
    Gupta P, King C, Benjamin L et al (2015) Association of hematocrit and red blood cell transfusion with outcomes in infants undergoing Norwood operation. Pediatr Cardiol 36:1212–1218CrossRefPubMedGoogle Scholar
  8. 8.
    Rajasekaran S, Kort E, Hackbarth R et al (2016) Red cell transfusions as an independent risk for mortality in critically ill children. J Intensiv Care 4:2–9CrossRefGoogle Scholar
  9. 9.
    Cholette J, Rubenstein J, Alfieris G et al (2011) Children with single-ventricle physiology do not benefit from higher hemoglobin levels post cavopulmonary connection: results of a prospective, randomized, controlled trial of a restrictive versus liberal red-cell transfusion strategy. Pediatr Crit Care Med 12:39–45CrossRefPubMedGoogle Scholar
  10. 10.
    Cholette JM, Mf Swartz, Rubenstein J et al (2017) Outcomes using a conservative versus liberal red blood cell transfusion strategy in infants requiring cardiac operation. Ann Thorac Surg 103:206–214CrossRefPubMedGoogle Scholar
  11. 11.
    Gas-Bakker De, de Wilde Hazekamp et al (2013) Safety and effects of two red blood cell transfusion strategies in pediatric cardiac surgery patients: a randomized controlled trial. Intensiv Care Med 39:2011–2019CrossRefGoogle Scholar
  12. 12.
    Mazine A, Rached-D’Astous S, Ducruet T et al (2015) Blood transfusions after pediatric cardiac operations: a North American multicenter prospective study. Ann Thorac Surg 100:671–677CrossRefPubMedGoogle Scholar
  13. 13.
    Tremblay-Roy JS, Poirier N, Ducruet T (2016) Red blood cell transfusion in the postoperative care of pediatric surgery: survey on stated practice. Pediatric Cardiol 37:1266–1273CrossRefGoogle Scholar
  14. 14.
    Delgado-Corcoran C, Wolpert K, Lucas K et al (2016) Hematocrit levels, blood testing, and transfusion in infants after heart surgery. Pediatr Crit Care Med 11:1387–1394Google Scholar
  15. 15.
    Ohye RG, Sleeper LA, Mahoni L et al (2010) Comparison of shunt types in the Norwood procedure for single ventricle lesions. N Engl J Med 362:1980–1992CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Tweddell JS, Ghanayem NS, Hoffman GM (2010) Pro: NIRS is: “standard of care” for postoperative management. Semin Thorac Cardiovascu Surg Pediatr Card Surg Ann 13:44–50CrossRefGoogle Scholar
  17. 17.
    Ghanagyem NS, Wernovsky G, Hoffman GM (2011) Near-infrared spectroscopy as a hemodynamic monitor in critical illness. Pediatr Crit Care Med. 12:S27–S32CrossRefGoogle Scholar
  18. 18.
    Costello JM, Polito A, Brown DW et al (2010) Birth before 39 weeks’s gestation is associated with worse outcomes in neonates with heart disease. Pediatrics 126:277–284CrossRefPubMedGoogle Scholar
  19. 19.
    Costello JM, Pasquali SK, Jacobs JP et al (2014) Gestational age at birth and outcomes after neonatal cardiac surgery: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Circulation 129:2511–2517CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Hill GD, Heir DA, Bartz PJ et al (2014) Effect of feeding modality on interstage growth following stage 1 palliation: a report from the national pediatric cardiology quality improvement collaborative. J Thorac Cardiovas Surg 148:1534–1539CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Claudia Delgado-Corcoran
    • 1
  • Deborah U. Frank
    • 2
  • Stephanie Bodily
    • 3
  • Chong Zhang
    • 4
  • Katherine H. Wolpert
    • 1
  • Kathryn Lucas
    • 3
  • Theodore J. Pysher
    • 5
  • Angela P. Presson
    • 4
  • Susan L. Bratton
    • 1
  1. 1.Department of Pediatrics, Division of Pediatric Critical Care Medicine, School of MedicineUniversity of UtahSalt Lake CityUSA
  2. 2.Department of Pediatrics, Division of Pediatric Critical Care Medicine, School of MedicineUniversity of VirginiaCharlottesvilleUSA
  3. 3.Primary Children’s Hospital, Intermountain Health CareSalt Lake CityUSA
  4. 4.Department of Internal Medicine, Division of Epidemiology, School of MedicineUniversity of UtahSalt Lake CityUSA
  5. 5.Department of Pathology, Division of Pediatric Pathology, School of MedicineUniversity of UtahSalt Lake CityUSA

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