For infants with shunt-dependent or ductal-dependent single ventricle heart disease,
poor growth is common and associated with morbidity and impaired neurodevelopmental
outcomes. Although attention has focused on nutrition to promote weight gain, little
is known about the relation between heart failure and growth factors. A prospective
observational pilot study was performed to assess the relation between heart failure,
assessed by brain natriuretic peptide (BNP), and growth factors (insulin-like growth
factor 1 [IGF-1] and insulin-like growth factor-binding protein 3) at 3 visits: (1)
before discharge from neonatal intervention with the establishment of stable pulmonary
blood flow, (2) immediately before superior cavopulmonary connection, and (3) before
discharge after superior cavopulmonary connection operation. The relation between
BNP and growth factors was analyzed using Spearman pairwise correlations at each visit
and modeled over time with a linear mixed-effects model. Correlations were considered
worthy of further exploration using a p <0.10, given the exploratory nature of the
study. The study included 38 infants (66% male, 68% hypoplastic left heart syndrome).
Median BNP was elevated at visit 1 and decreased over time (287 pg/dl [interquartile
range 147 to 794], 85 pg/dl [52 to 183], and 90 pg/dl [70 to 138]). Median IGF-1 Z score was <0 at each visit but increased over time (−0.9 [interquartile range −1.1
to 0.1], −0.7 [−1.2 to 0.1], and −0.5 [−1.2 to 0]). Inverse correlations were found
between BNP and IGF-1 at visit 1 (r = −0.40, p = 0.097), BNP and IGF-1 and insulin-like
growth factor-binding protein 3 at visit 2 (r = −0.33, p = 0.080 and r = −0.33, p = 0.085, respectively) and BNP and IGF-1 Z score at visit 3 (r = −0.42, p = 0.049). Significant relations were likewise found
between the change in BNP and the change in IGF-1 between visits 1 and 3 (p = 0.046)
and between visits 2 and 3 (p = 0.048). In conclusion, this pilot study demonstrates
an inverse correlation between BNP and growth factors, suggesting that the heart failure
state associated with this physiology may play a mechanistic role in impaired growth.
Abbreviations:
BNP (Brain natriuretic peptide), IGF-1 (Insulin-like growth factor 1), SD-SVHD (Shunt-dependent single ventricle heart disease), SVHD (Single ventricle heart diseease)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: March 11, 2022
Received in revised form:
January 20,
2022
Received:
December 19,
2021
Footnotes
This work was supported in part by the Cardiac Center Clinical Research Core at The Children's Hospital of Philadelphia (Philadelphia, Pennsylvania) and The Matthews Heart of Hope Grant (Sherman, Connecticut).
Funding for this project was obtained through the Gerber Foundation (identification 4231).
Identification
Copyright
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