Normal interstage growth after the norwood operation associated with interstage home monitoring

Abstract

After stage 1 palliation (S1P) with a Norwood operation, infants commonly experience growth failure during the initial interstage period. Growth failure during this high-risk period is associated with worse outcomes. This study evaluated the growth patterns of patients enrolled in the authors' interstage home-monitoring program (HMP), which uses a multidisciplinary team approach to nutrition management. From 2000 to 2009, 148 infants were enrolled in the HMP after S1P. Families recorded daily weights during the interstage period and alerted the interstage monitoring team about protocol violations of nutritional goals. Interstage monitoring and inpatient data from the S1P hospitalization were reviewed to identify risk factors for poor growth. Growth outcomes were compared with published norms from the Centers for Disease Control. Interstage survival for patients in the HMP was 98 % (145/148). Growth velocity during the interstage period was 26 ± 8 g/day. The weight-for-age z-scores decreased from birth to discharge after S1P (-0.4 ± 0.9 to -1.3 ± 0.9; p < 0.001) but then increased during the interstage period to the time of S2P (-0.9 ± 1; p < 0.001). The factors associated with improved growth during the interstage period included male gender, greater birth weight, full oral feeding at S1P discharge, and a later birth era. After S1P, infants enrolled in an HMP experienced normal growth velocity during the interstage period. Daily observation of oxygen saturation, weight change, and enteral intake together with implementation of a multidisciplinary feeding protocol is associated with excellent interstage growth and survival.

Fig. 1

Patient population. HMP home monitoring program, S1P stage 1 palliation, S2P stage 2 palliation

Fig. 2

Weight-for-age z-score (WAZ) at birth, at discharge after S1P, and at S2P admission. Dashed line represents normal weight (WAZ = 0), and dotted line represents growth failure (WAZ = 2)

Fig. 3

Interstage growth velocity. a Study cohort versus Centers for Disease Control (CDC) normal growth. b Patients with a gastrostomy tube (GT) versus no GT. c Birth era comparison. G-tube, gastrostomy tube