Site of interstage outpatient care and growth after the Norwood operation

AbstractBackgroundRecent efforts have focused on optimising interstage outcomes, including growth, for infants following the Norwood operation. The impact of the site of interstage care remains unclear, and it has been hypothesised that care at the surgical site may be beneficial due to greater access to resources such as nutritional support. This study evaluated the relationship between site of interstage care and weight gain in a large multicentre cohort.MethodsInfants enrolled in the National Paediatric Cardiology Quality Improvement Collaborative (2008–2013) surviving up to Stage 2 were included. Change in weight-for-age z-score between Norwood discharge and Stage 2 admission was compared in those receiving care at the surgical versus non-surgical site.ResultsOf the 487 interstage survivors, 60% received all care at the surgical site, and 40% received care at a non-surgical site. There was no significant difference between groups in change in weight-for-age z-score: +0.36±0.96 for the surgical site group versus +0.46±1.02 for the non-surgical site group, p=0.3. Results were unchanged in multivariable analysis adjusting for differences in important baseline characteristics, duration of interstage, and home surveillance strategy. The proportion of all patients with weight-for-age z-score <−2 decreased from 40% at Norwood discharge to 29% at Stage 2, with no significant difference in change between the two groups (p=0.1).ConclusionsThe site of interstage care was not associated with weight gain during the interstage period. Nearly one-third of patients overall had a weight-for-age z-score <−2 at Stage 2. Further study is required to identify methods to optimise weight gain in these patients.

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Weight change in infants with a functionally univentricular heart: from surgical intervention to hospital discharge

Cardiology in the Young ◽

10.1017/s104795111000154x ◽

2010 ◽

Vol 21 (2) ◽

pp. 136-144 ◽

Cited By ~ 38

Author(s):

Barbara Medoff-Cooper ◽

Sharon Y. Irving ◽

Bradley S. Marino ◽

J. Felipe García-España ◽

Chitra Ravishankar ◽

...

Keyword(s):

Weight Gain ◽

Hospital Discharge ◽

Weight Change ◽

Surgical Intervention ◽

Atrioventricular Valve ◽

Z Score ◽

Valve Regurgitation ◽

Atrioventricular Valve Regurgitation ◽

Significant Difference ◽

Weight For Age

AbstractObjectiveThe purpose of this study was to assess the pattern of weight change from surgical intervention to home discharge and to determine predictors of poor growth in this population of infants with congenital cardiac disease.MethodsNeonates with functionally univentricular physiology enrolled in a prospective cohort study examining growth between March, 2003 and May, 2007 were included. Weights were collected at birth, before surgical intervention, and at hospital discharge. In addition, retrospective echocardiographic data and data about post-operative complications were reviewed. Primary outcome variables were weight-for-age z-score at discharge and change in weight-for-age z-score between surgery and discharge.ResultsA total of 61 infants met the inclusion criteria. The mean change in weight-for-age z-score between surgery and hospital discharge was minus 1.5 plus or minus 0.8. Bivariate analysis revealed a significant difference in weight-for-age z-score between infants who were discharged on oral feeds, minus 1.1 plus or minus 0.8 compared to infants with feeding device support minus 1.7 plus or minus 0.7, p-value equal to 0.01. Lower weight-for-age z-score at birth, presence of moderate or greater atrioventricular valve regurgitation, post-operative ventilation time, and placement of an additional central venous line were associated with 60% of the variance in weight-for-age z-score change.ConclusionNeonates undergoing staged surgical repair for univentricular physiology are at significant risk for growth failure between surgery and hospital discharge. Haemodynamically significant atrioventricular valve regurgitation and a complex post-operative course were risk factors for poor post-operative weight gain. Feeding device support appears to be insufficient to ensure adequate weight gain during post-operative hospitalisation.

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Interstage feeding and weight gain in infants following the Norwood operation: can we change the outcome?

Cardiology in the Young ◽

10.1017/s1047951111002083 ◽

2012 ◽

Vol 22 (5) ◽

pp. 520-527 ◽

Cited By ~ 16

Author(s):

Karen Uzark ◽

Yu Wang ◽

Nancy Rudd ◽

E. Marsha Elixson ◽

Jennifer Strawn ◽

...

Keyword(s):

Weight Gain ◽

Stage I ◽

Stage Ii ◽

Daily Weight Gain ◽

Z Score ◽

Norwood Operation ◽

Average Daily Weight Gain ◽

Feeding Groups ◽

Over Time ◽

Weight For Age

AbstractBackgroundPoor weight gain is common in infants after Stage I Norwood operation and can negatively impact outcomes.ObjectivesThe purpose of this study was to examine the impact of feeding strategy on interstage weight gain.MethodsIn a multi-centre study, 158 infants discharged following the Norwood operation were enrolled prospectively. Weight and feeding data were obtained at 2-week intervals. Differences between feeding regimens in average daily weight gain and change in weight-for-age z-score between Stage I discharge and Stage II surgery were examined.ResultsDischarge feeding regimens were oral only in 52%, oral with tube supplementation in 33%, and by nasogastric/gastrostomy tube only in 15%. There were significant differences in the average daily interstage weight gain among the feeding groups – oral only 25.0 grams per day, oral/tube 21.4 grams per day, and tube only 22.3 grams per day – p = 0.019. Tube-only-fed infants were significantly older at Stage II (p = 0.004) and had a significantly greater change in weight-for-age z-score (p = 0.007). The overall rate of weight gain was 16–32 grams per day, similar to infant norms. The rate of weight gain declined over time, with earlier decline observed for oral- and oral/tube-fed infants (less than 15 grams per day at 5.4 months) in comparison with tube-only-fed infants (less than 15 grams per day at 8.6 months).ConclusionFollowing Stage I Norwood, infants discharged on oral feeding had better average daily weight gain than infants with tube-assisted feeding. The overall weight gain was within the normal limits in all feeding groups, but the rate of weight gain decreased over time, with an earlier decline in infants fed orally.

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The Efficacy of Etoposide-Based Therapy in Adult Secondary Hemophagocytic Lymphohistiocytosis

Acta Haematologica ◽

10.1159/000514920 ◽

2021 ◽

pp. 1-9

Author(s):

Leonard Naymagon ◽

Douglas Tremblay ◽

John Mascarenhas

Keyword(s):

Hemophagocytic Lymphohistiocytosis ◽

Proportional Hazards ◽

Multivariable Analysis ◽

Cox Proportional Hazards ◽

Rank Test ◽

Kaplan Meier ◽

Hazard Ratios ◽

Significant Difference ◽

The Impact

Data supporting the use of etoposide-based therapy in hemophagocytic lymphohistiocytosis (HLH) arise largely from pediatric studies. There is a lack of comparable data among adult patients with secondary HLH. We conducted a retrospective study to assess the impact of etoposide-based therapy on outcomes in adult secondary HLH. The primary outcome was overall survival. The log-rank test was used to compare Kaplan-Meier distributions of time-to-event outcomes. Multivariable Cox proportional hazards modeling was used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). Ninety adults with secondary HLH seen between January 1, 2009, and January 6, 2020, were included. Forty-two patients (47%) received etoposide-based therapy, while 48 (53%) received treatment only for their inciting proinflammatory condition. Thirty-three patients in the etoposide group (72%) and 32 in the no-etoposide group (67%) died during follow-up. Median survival in the etoposide and no-etoposide groups was 1.04 and 1.39 months, respectively. There was no significant difference in survival between the etoposide and no-etoposide groups (log-rank <i>p</i> = 0.4146). On multivariable analysis, there was no association between treatment with etoposide and survival (HR for death with etoposide = 1.067, 95% CI: 0.633–1.799, <i>p</i> = 0.8084). Use of etoposide-based therapy was not associated with improvement in outcomes in this large cohort of adult secondary HLH patients.

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Abstract 4603: Home Surveillance Results in Improved Interstage Weight Gain in Infants following the Norwood Operation

Circulation ◽

10.1161/circ.118.suppl_18.s_919-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Karen Uzark ◽

Paula Eldridge ◽

William Border ◽

Mary Pat Alfaro ◽

Megan Donley ◽

...

Keyword(s):

Weight Gain ◽

Length Of Stay ◽

Hospital Length ◽

Stage I ◽

Stage Ii ◽

Hospital Length Of Stay ◽

Complex Congenital Heart Disease ◽

Norwood Operation ◽

Weight Monitoring ◽

The Impact

Infants with complex congenital heart disease are at increased risk for malnutrition and poor weight gain. At our institution, infants who undergo Stage I Norwood operation are discharged with a home surveillance (HomeSurv) program which includes weight monitoring. To evaluate the impact of home surveillance on interstage growth, a current cohort of patients enrolled in Home Surv (n=18) was compared to a cohort discharged immediately prior to the implementation of the Home Surv program (n=20). The cohorts were compared using parametric and non-parametric methods as appropriate. Results: Infants underwent Stage I at a median age of 3.5 days (range 1–26), and at a mean weight 3.0 ± 0.4 kg., 26 with a modified Blalock-Taussig shunt and 12 with a right ventricular-to-pulmonary artery shunt. There were 26 males and 12 females. There were no significant differences between the groups with and without HomeSurv with respect to Stage I age, sex, Stage I weight, or shunt type. Stage I discharge weights were similar between the two cohorts (p=0.23) and there was no significant difference in Stage I hospital length of stay (p=0.10). Mean age at Stage II was 5.1 mos in the HomeSurv group and 4.9 mos in the pre-HomeSurv group, (p = 0.63). Mean weight at Stage II was higher in the HomeSurv group, but not statistically significant (5.9 kg vs 5.5 kg, p=0.30). However, weight gain >15 gms/day post Stage I discharge (our minimum weight gain threshold) was achieved by 89% of infants with Home Surv in comparison to 60% of the pre-HomeSurv group, p<.05. Weight gain was not significantly correlated with weight at Stage I, Stage I hospital length of stay, or age at Stage II, and was not significantly different related to shunt type. Conclusion: Home surveillance including weight monitoring following Stage I Norwood positively impacts interstage weight gain. In particular, it appears to confer protection for at-risk infants who fall below the threshold weight gain of 15gms/day. Future studies should explore whether this improved weight gain is an important factor in interstage morbidity and mortality.

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Enhanced surveillance for covid-19 response in Lagos State, Nigeria: lessons learnt, 2020 (Preprint)

10.2196/preprints.33075 ◽

2021 ◽

Author(s):

Gregory Chukwuemeka Umeh ◽

Khalid Abubakar ◽

Peter Akinmusire ◽

Adamu M. Isa ◽

Aminu Zauro ◽

...

Keyword(s):

Service Industry ◽

Respiratory Infections ◽

Health Facilities ◽

Acute Respiratory Infections ◽

Surveillance Strategy ◽

Active Case ◽

Governmental Organizations ◽

Significant Difference ◽

Lagos State ◽

The Impact

BACKGROUND The SARS-CoV-2, the novel virus which causes the coronavirus disease (COVID-19), has changed the world. No aspect of humanity is untouched from health, aviation, service industry, politics, economy, education, and entertainment to social and personal lives, since the outbreak of influenza-like illness in Wuhan, China, in December 2019. The Lagos State COVID-19 response team deployed enhanced surveillance through Active Case Search (ACS) for Acute Respiratory Infections (ARI) at health facilities and communities in the 20 Local Government Areas (LGAs) of Lagos State. Lagos State was the first state in Nigeria to deploy this specific surveillance strategy for Nigeria’s COVID-19 response. OBJECTIVE We documented the methods, findings, and review of the active case search for acute respiratory infections, part of COVID-19 response in 20 LGAs of Lagos State, between 1st April and 15th May 2020. METHODS We utilized descriptive and quantitative approaches to describe and assess the impact of the Active Case Search (ACS) for Acute Respiratory Infections (ARI) in health facilities and communities in 20 LGAs of Lagos State between 1st April and 15th May 2020. RESULTS We found a significant difference in mean scores of suspected COVID-19 cases (M=60, SD=109, before ACS for ARI compared to M=568, SD=732, after ACS for ARI, P=0.0039), confirmed cases (M=10, SD=19, before ACS for ARI compared to M=144, SD=187, after ACS for ARI, P=0.0028) and contacts (M=56, SD=116, before ACS for ARI compared to M=152, SD=177, after ACS for ARI, P=0.044) before and after ACS for ARI in 20 LGAs of Lagos State, between 1st April and 15th May 2020. CONCLUSIONS The deployment of the Lagos State government’s polio-eradication structure for the COVID-19 response is both innovative and effective. The response to COVID-19 requires robust surveillance, credible and timely communication, collaboration, coordination among government, inter-governmental organizations (e.g., WHO), non-governmental organizations, and citizens to succeed and limit the medical, economic, social, and personal losses to the COVID-19 pandemic.

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The association between feeding protocol compliance and weight gain following high-risk neonatal cardiac surgery

Cardiology in the Young ◽

10.1017/s1047951119000222 ◽

2019 ◽

Vol 29 (5) ◽

pp. 594-601 ◽

Cited By ~ 1

Author(s):

Jamie M. Furlong-Dillard ◽

Benjamin J. Miller ◽

Kathy A. Sward ◽

Alaina I. Neary ◽

Trudy L. Hardin-Reynolds ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Weight Gain ◽

High Risk ◽

Congenital Heart ◽

Clinical Severity ◽

Z Score ◽

Protocol Adherence ◽

Feeding Protocol ◽

Weight For Age

AbstractBackground:Children with congenital heart disease are at high risk for malnutrition. Standardisation of feeding protocols has shown promise in decreasing some of this risk. With little standardisation between institutions’ feeding protocols and no understanding of protocol adherence, it is important to analyse the efficacy of individual aspects of the protocols.Methods:Adherence to and deviation from a feeding protocol in high-risk congenital heart disease patients between December 2015 and March 2017 were analysed. Associations between adherence to and deviation from the protocol and clinical outcomes were also assessed. The primary outcome was change in weight-for-age z score between time intervals.Results:Increased adherence to and decreased deviation from individual instructions of a feeding protocol improves patients change in weight-for-age z score between birth and hospital discharge (p = 0.031). Secondary outcomes such as markers of clinical severity and nutritional delivery were not statistically different between groups with high or low adherence or deviation rates.Conclusions:High-risk feeding protocol adherence and fewer deviations are associated with weight gain independent of their influence on nutritional delivery and caloric intake. Future studies assessing the efficacy of feeding protocols should include the measures of adherence and deviations that are not merely limited to caloric delivery and illness severity.

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An evaluation of the impact of a school nutrition programme in Vietnam

Public Health Nutrition ◽

10.1017/s1368980007382530 ◽

2007 ◽

Vol 10 (8) ◽

pp. 819-826 ◽

Cited By ~ 10

Author(s):

Andrew Hall ◽

Tran Thi Minh Hanh ◽

Katherine Farley ◽

Tran Pham Nha Quynh ◽

Frank Valdivia

Keyword(s):

Weight Gain ◽

Primary Schools ◽

School Nutrition ◽

Cross Sectional ◽

Cluster Evaluation ◽

Significant Difference ◽

Level Model ◽

Grade 3 ◽

The Impact ◽

Nutrition Programme

AbstractObjectiveTo evaluate the effectiveness of a school nutrition programme on the weight gain and growth of Vietnamese schoolchildren.DesignA proximate cluster evaluation of children in seven schools, in which fortified milk and biscuits supplying 300 kcal of energy were being given on school days, compared with children in 14 nearby schools with no feeding. All children were dewormed.SettingTwenty-one primary schools in Dong Thap Province, Vietnam.SubjectsA cohort of 1080 children in grade 1 of 21 primary schools, and a cross-sectional interview of 400 children in grade 3.ResultsThe programme gave children the equivalent of 90 kcal day− 1 over 17 months. t-Tests showed a small but statistically significant difference between groups in their average gain in weight and height: 3.19 versus 2.95 kg (P < 0.001) and 8.15 versus 7.88 cm (P = 0.008). A multiple-level model showed that the programme was statistically significant after controlling for clustering of children in schools, sex, age and initial underweight (P = 0.024). A significant impact on height was also seen in a regression model, but not when controlling for school. The most undernourished children tended to gain the least weight. There was no evidence of substitution.ConclusionThe programme had a small but significant effect on weight gain, but the most undernourished children benefited the least. Methods need to be developed to target them. This design may offer a means of estimating the impact of school feeding on growth in other programme settings.

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Changing Patterns in Lifestyle, Food Intake and Health Status between Selected Beneficiary People and Non-beneficiary People of Urban Slum in Dhaka City

Bangladesh Journal of Nutrition ◽

10.3329/bjnut.v24i0.14033 ◽

2013 ◽

pp. 15-22 ◽

Cited By ~ 1

Author(s):

MS Islam ◽

AAM Kurshed ◽

TMA Azad ◽

MAH Bhuyan

Keyword(s):

Food Intake ◽

Nutritional Status ◽

Poor People ◽

Dhaka City ◽

Z Score ◽

Monthly Income ◽

Full Stomach ◽

Food Items ◽

Significant Difference ◽

Weight For Age

To see the improvement in lifestyle, food intake and nutritional status of Beneficiary people of Shiree Project under Dushtha Shasthya Kendra, a comparative cross sectional study was done in Kamrangirchar slum among extreme poor people of Dhaka city and compared with nonbeneficiary households. Beneficiary households of MDG-1 under Shiree Project got household economic intervention packages. In this stuy it is found that mean monthly income of the family was 6175.65 Tk in beneficiary group and 4288.14 Tk in non-beneficiary group. The mean monthly expenditure on food items of family was 3787.83 Tk in beneficiary group and 2796.61 Tk in non-beneficiary group. About 34 percent beneficiary households and 75 percent of all non-beneficiary households were poor having households monthly income less than 3000 taka. Some 15.7 percent beneficiary households had five amenities out of selected six and only 1.7 percent non-beneficiary households had five amenities. So, socio-economic condition of beneficiary extreme poor people has improved. Consumption of food items was significantly more in beneficiary households than non-beneficiary ones. Some 74 percent beneficiary households consumed four or more food items daily and 26 percent non-beneficiary households consumed four or more food items daily. On average 3.37 food items were consumed by beneficiary households and 2.49 food items by non-beneficiary households daily. More than 60% of the beneficiary people ate full stomach meals and less than 25 % of non-beneficiary people could afford to eat the same. So, beneficiary people were more food secure and more food diversified than non-beneficiary people. Nutritional status of the children by MUAC, Weight for Age Z-score, and Height for Age Z-score showed no significant difference between beneficiary and non-beneficiary group. Prevalence rate of underweight (Weight for Age Z-score) was 60.5% in beneficiary children and 65.9% in non-beneficiary children. Significant difference (P=0.044) was found by Weight for Height Z-score in both beneficiary and non-beneficiary group. The difference of mothers nutritional status by BMI between beneficiary group and non-beneficiary group was not statistically significant, though percentage of CED was lower and overweight was higher in beneficiary mothers than non-beneficiary ones. Though socio-economic status, food security and food intake were better in beneficiary people than non-beneficiary ones, the outcome of these factors were not significant in clinical and anthropometric status. Beneficiary households were on the way to meet first target of MGD-1 which is related to poverty reduction. But they were far away from reaching the second target and halving prevalence of underweight as described in MDG-1. DOI: http://dx.doi.org/10.3329/bjnut.v24i0.14033 Bangladesh J. Nutr. Vol. 24-25 Dec 2011-2012 pp.15-22

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1224 Effect of Distal Brachioradialis Release During Open Reduction and Internal Fixation of Distal Radius Fractures

British Journal of Surgery ◽

10.1093/bjs/znab259.1033 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Hafez ◽

A Shaat ◽

M Zain ◽

M A Sajid ◽

A Butt

Keyword(s):

Internal Fixation ◽

Distal Radius ◽

Open Reduction ◽

Group Versus ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Volar Approach ◽

Normal Ranges ◽

Significant Difference ◽

The Impact

Abstract Aim The study aim is to determine the impact of the brachioradialis release during the open reduction and internal fixation of distal radius fractures using a volar approach Method Total of 40 patients was treated with Open reduction and internal fixation of intra articular distal radius fractures. Distal release of Brachioradialis was performed to 19 patients, while 21 patients had no release of BR during surgery. Radiological parameters including Radial height, Inclination and volar tilt were measured 1 month post-operatively, while functional outcomes assessed with modified mayo wrist scores and Quick-dash scores Results There is no significant difference between age, gender and pre-operative conditions indicating that both the groups (BR release and without BR release) have similar demographic characteristics. Pre-operatively both groups had disturbed values for radial height, inclination, and volar tilt. Postoperatively, the mean of both groups was closer to normal ranges for radial inclination and volar tilt; however, radial height was the least adequately restored radiological parameter for both study group (11.54 ± 1.35 for BR group versus 10.21 ± 2.29 for Non-BR group). Pain, functional status, and grip strength had similar values in both groups whereas BR group showed higher ROM and DASH scores with P values of 0.048 and 0.025 respectively. Conclusions Brachioradialis release enhances the reduction and operative fixation, restoring the necessary radiological and subsequent functional parameters in distal radius fractures with reported no complications.

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Maternal MTNR1B genotype, maternal gestational weight gain, and childhood obesity

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqz296 ◽

2019 ◽

Vol 111 (2) ◽

pp. 360-368 ◽

Cited By ~ 2

Author(s):

Zhaoxia Liang ◽

Huikun Liu ◽

Leishen Wang ◽

Yuhang Chen ◽

Tao Zhou ◽

...

Keyword(s):

Weight Gain ◽

Childhood Obesity ◽

Waist Circumference ◽

Gestational Weight Gain ◽

Body Fat ◽

Overweight And Obesity ◽

Z Score ◽

Gestational Weight ◽

Childhood Overweight And Obesity ◽

Weight For Age

ABSTRACT Background Maternal metabolic abnormalities have been related to offspring obesity especially during childhood. Objectives We analyzed whether the gestational diabetes mellitus (GDM)-associated melatonin receptor 1B (MTNR1B) genotype of mothers modified the relation between maternal gestational weight gain and childhood obesity. Methods A total of 1114 Chinese mother-child pairs (mothers with or without prior GDM) were included. Mothers’ MTNR1B rs10830962 genotype and gestational weight gain were assessed. Indicators of childhood obesity included BMI-for-age z-score, weight-for-age z-score, waist circumference, and body fat. Childhood overweight and obesity were also analyzed. Results We found that the maternal MTNR1B genotype significantly interacted with gestational weight gain on indicators of offspring's obesity (all P for interaction < 0.05). After multivariable adjustment, BMI-for-age z-scores associated with 1-kg gestational weight gain were 0.009 (SE 0.018), 0.026 (SE 0.010), and 0.061 (SE 0.010) in children with the maternal MTNR1B genotype CC, CG, and GG, respectively (P-interaction = 0.012). Similar interactions were observed for weight-for-age z-score, waist circumference, and body fat (P-interaction = 0.001, 0.003, and 0.012, respectively). The associations remained consistently significant in women with and without GDM. We also found significant interactions between the maternal MTNR1B genotype and gestational weight gain on the offspring's childhood overweight and obesity (P-interaction = 0.005 and 0.026, respectively). Conclusions The maternal MTNR1B genotype might interact with gestational weight gain on offspring's obesity risk during childhood.

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