Growth in Children with a Fontan Circulation

Objective To evaluate growth in a population of patients with Fontan circulation. Study design We performed a cross-sectional evaluation of patients followed in our multidisciplinary Fontan clinic from January 2011 through August 2015. We reviewed the historical data, anthropometry, clinical, and laboratory studies and performed bivariate and multivariate analysis of factors associated with height z-score. Results Patients (n= 210) were included in the study at median age 11.07 years (8.3, 14.73) (43% female); 138 (65%) had a dominant right systemic ventricle, 92 (44%) hypoplastic left heart syndrome. Median age at completion of Fontan circulation was 31 months. (7.6, 135.8). Median height z-score was -0.58 (-1.75, 0.26). Twenty-five (12%) had current or past history of protein losing enteropathy (PLE). Median height z-score for those with current or past history of PLE was -2.1 (-2.46, 1.24). Multivariate analysis revealed positive associations between height z-score and body mass index (BMI) z-score, time since Fontan, mid-parental height, dominant systemic ventricle type, and serum alkaline phosphatase. Height correlated negatively with known genetic syndrome, PLE, use of stimulant or oral steroid medication. Conclusions Children with Fontan circulation have mild deficits in height, with greater deficits in those with PLE. Height z- score improves with time post-surgery. Improving weight, leading to improved BMI may be a modifiable factor that improves growth in those who are underweight. Biochemical markers may be helpful screening tests for high risk groups in whom to intensify interventions.