Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA; Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA.
J Pediatr. 2024 Apr;267:113901. doi: 10.1016/j.jpeds.2024.113901. Epub 2024 Jan 3.
To evaluate patterns and determinants of longitudinal growth among children requiring complex biventricular repair for congenital heart disease, as well as to assess for associations of growth with early feeding modality, comorbidities, postoperative complications, and socioeconomic characteristics.
A single-institution retrospective cohort study was performed in children born February 1999 to March 2009 with complex congenital heart disease who underwent biventricular repair before age 4 years, defined by Risk Adjustment in Congenital Heart Surgery-1 category 3-5. Clinical characteristics, height, weight, and body mass index (BMI) from ages 2-12 years were collected by chart review. Neighborhood-level socioeconomic data were identified using a geographic information system approach. The adjusted association of covariates with growth outcomes was estimated using multivariable linear regression models using generalized estimating equations.
Compared with population growth curves, the cohort (n = 150) trended toward early decrease in age-adjusted weight and height. Early tube feeding was significantly associated with decreased BMI before adolescence (-0.539; 95% CI -1.02, -0.054; P = .029). In addition, other clinical and perioperative characteristics had significant associations with growth, including low birth weight, preoperative tube feeds, need for multiple bypass runs, and diagnosis of feeding disorder.
Early childhood growth in children with complex biventricular repair may be impaired. Early tube feeding was associated with decreased BMI over the course of early childhood, which may indicate a need for continued close nutrition follow-up and support even beyond the duration of tube feeds.
评估需要复杂双心室修复的先天性心脏病儿童的纵向生长模式和决定因素，并评估生长与早期喂养方式、合并症、术后并发症和社会经济特征的关系。
这是一项单中心回顾性队列研究，纳入了 1999 年 2 月至 2009 年 3 月期间出生的患有复杂先天性心脏病且在 4 岁之前接受了双心室修复的儿童，该修复术由先天性心脏病手术风险调整-1 分类 3-5 定义。通过病历回顾收集了 2 至 12 岁时的临床特征、身高、体重和体重指数（BMI）。使用地理信息系统方法确定了邻里水平的社会经济数据。使用广义估计方程的多变量线性回归模型来估计协变量与生长结果的调整关联。
与人群生长曲线相比，该队列（n=150）在年龄调整后的体重和身高方面呈现早期下降趋势。早期管饲与青春期前 BMI 降低显著相关（-0.539；95%CI -1.02，-0.054；P=0.029）。此外，其他临床和围手术期特征与生长有显著关联，包括低出生体重、术前管饲、需要多次旁路运行和诊断为喂养障碍。
患有复杂双心室修复的儿童在幼儿期的生长可能受损。早期管饲与儿童早期 BMI 降低有关，这可能表明即使在管饲期间过后，也需要持续密切的营养随访和支持。
