Neighborhood Social Vulnerability and Interstage Weight Gain: Evaluating the Role of a Home Monitoring Program
Background Poor interstage weight gain is a risk factor for adverse outcomes in infants with hypoplastic left heart syndrome. We sought to examine the association of neighborhood social vulnerability and interstage weight gain and determine if this association is modified by enrollment in our instit...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.030029 |
| _version_ | 1797632552932999168 |
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| author | Rachel J. Shustak Jing Huang Vicky Tam Alyson Stagg Therese M. Giglia Chitra Ravishankar Laura Mercer‐Rosa James P. Guevara Monique M. Gardner |
| author_facet | Rachel J. Shustak Jing Huang Vicky Tam Alyson Stagg Therese M. Giglia Chitra Ravishankar Laura Mercer‐Rosa James P. Guevara Monique M. Gardner |
| author_sort | Rachel J. Shustak |
| collection | DOAJ |
| description | Background Poor interstage weight gain is a risk factor for adverse outcomes in infants with hypoplastic left heart syndrome. We sought to examine the association of neighborhood social vulnerability and interstage weight gain and determine if this association is modified by enrollment in our institution's Infant Single Ventricle Management and Monitoring Program (ISVMP). Methods and Results We performed a retrospective single‐center study of infants with hypoplastic left heart syndrome before (2007–2010) and after (2011–2020) introduction of the ISVMP. The primary outcome was interstage weight gain, and the secondary outcome was interstage growth failure. Multivariable linear and logistic regression models were used to examine the association between the Social Vulnerability Index and the outcomes. We introduced an interaction term into the models to test for effect modification by the ISVMP. We evaluated 217 ISVMP infants and 111 pre‐ISVMP historical controls. The Social Vulnerability Index was associated with interstage growth failure (P=0.001); however, enrollment in the ISVMP strongly attenuated this association (P=0.04). Pre‐ISVMP, as well as high‐ and middle‐vulnerability infants gained 4 g/d less and were significantly more likely to experience growth failure than low‐vulnerability infants (high versus low: adjusted odds ratio [aOR], 12.5 [95% CI, 2.5–62.2]; middle versus low: aOR, 7.8 [95% CI, 2.0–31.2]). After the introduction of the ISVMP, outcomes did not differ by Social Vulnerability Index tertile. Infants with middle and high Social Vulnerability Index scores who were enrolled in the ISVMP gained 4 g/d and 2 g/d more, respectively, than pre‐ISVMP controls. Conclusions In infants with hypoplastic left heart syndrome, high social vulnerability is a risk factor for poor interstage weight gain. However, enrollment in the ISVMP significantly reduces growth disparities. |
| first_indexed | 2024-03-11T11:38:35Z |
| format | Article |
| id | doaj.art-6e2ebd87db3a4833afbb435a2abb4b2c |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-11T11:38:35Z |
| publishDate | 2023-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-6e2ebd87db3a4833afbb435a2abb4b2c2023-11-10T10:23:41ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-09-01121810.1161/JAHA.123.030029Neighborhood Social Vulnerability and Interstage Weight Gain: Evaluating the Role of a Home Monitoring ProgramRachel J. Shustak0Jing Huang1Vicky Tam2Alyson Stagg3Therese M. Giglia4Chitra Ravishankar5Laura Mercer‐Rosa6James P. Guevara7Monique M. Gardner8Division of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia and Perelman School of Medicine University of Pennsylvania Philadelphia PA USADepartment of Biomedical and Health Informatics, Data Science and Biostatistics Unit The Children’s Hospital of Philadelphia Philadelphia PA USACartographic Modeling Lab University of Pennsylvania Philadelphia PA USADivision of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia and Perelman School of Medicine University of Pennsylvania Philadelphia PA USADivision of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia and Perelman School of Medicine University of Pennsylvania Philadelphia PA USADivision of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia and Perelman School of Medicine University of Pennsylvania Philadelphia PA USADivision of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia and Perelman School of Medicine University of Pennsylvania Philadelphia PA USADivision of General Pediatrics, Department of Pediatrics, The Children’s Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania Philadelphia PA USADivision of Cardiac Critical Care Medicine, The Children’s Hospital of Philadelphia and Department of Anesthesiology and Critical Care Perelman School of Medicine at the University of Pennsylvania Philadelphia PA USABackground Poor interstage weight gain is a risk factor for adverse outcomes in infants with hypoplastic left heart syndrome. We sought to examine the association of neighborhood social vulnerability and interstage weight gain and determine if this association is modified by enrollment in our institution's Infant Single Ventricle Management and Monitoring Program (ISVMP). Methods and Results We performed a retrospective single‐center study of infants with hypoplastic left heart syndrome before (2007–2010) and after (2011–2020) introduction of the ISVMP. The primary outcome was interstage weight gain, and the secondary outcome was interstage growth failure. Multivariable linear and logistic regression models were used to examine the association between the Social Vulnerability Index and the outcomes. We introduced an interaction term into the models to test for effect modification by the ISVMP. We evaluated 217 ISVMP infants and 111 pre‐ISVMP historical controls. The Social Vulnerability Index was associated with interstage growth failure (P=0.001); however, enrollment in the ISVMP strongly attenuated this association (P=0.04). Pre‐ISVMP, as well as high‐ and middle‐vulnerability infants gained 4 g/d less and were significantly more likely to experience growth failure than low‐vulnerability infants (high versus low: adjusted odds ratio [aOR], 12.5 [95% CI, 2.5–62.2]; middle versus low: aOR, 7.8 [95% CI, 2.0–31.2]). After the introduction of the ISVMP, outcomes did not differ by Social Vulnerability Index tertile. Infants with middle and high Social Vulnerability Index scores who were enrolled in the ISVMP gained 4 g/d and 2 g/d more, respectively, than pre‐ISVMP controls. Conclusions In infants with hypoplastic left heart syndrome, high social vulnerability is a risk factor for poor interstage weight gain. However, enrollment in the ISVMP significantly reduces growth disparities.https://www.ahajournals.org/doi/10.1161/JAHA.123.030029congenital heart diseasegrowthhealth disparitieshypoplastic left heart syndromeinterstage period |
| spellingShingle | Rachel J. Shustak Jing Huang Vicky Tam Alyson Stagg Therese M. Giglia Chitra Ravishankar Laura Mercer‐Rosa James P. Guevara Monique M. Gardner Neighborhood Social Vulnerability and Interstage Weight Gain: Evaluating the Role of a Home Monitoring Program Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease congenital heart disease growth health disparities hypoplastic left heart syndrome interstage period |
| title | Neighborhood Social Vulnerability and Interstage Weight Gain: Evaluating the Role of a Home Monitoring Program |
| title_full | Neighborhood Social Vulnerability and Interstage Weight Gain: Evaluating the Role of a Home Monitoring Program |
| title_fullStr | Neighborhood Social Vulnerability and Interstage Weight Gain: Evaluating the Role of a Home Monitoring Program |
| title_full_unstemmed | Neighborhood Social Vulnerability and Interstage Weight Gain: Evaluating the Role of a Home Monitoring Program |
| title_short | Neighborhood Social Vulnerability and Interstage Weight Gain: Evaluating the Role of a Home Monitoring Program |
| title_sort | neighborhood social vulnerability and interstage weight gain evaluating the role of a home monitoring program |
| topic | congenital heart disease growth health disparities hypoplastic left heart syndrome interstage period |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.030029 |
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