Efficacy of Gastrostomy-Button for Weight Gain in Patients with Hypoplastic Left Heart Syndrome

Purpose & Background: Hypoplastic left heart syndrome (HLHS) is a congenital heart defect (CHD) in which the left side of the heart is underdeveloped. HLHS makes up 2-3% of all CHD; 25-40% of neonatal cardiac death is due to untreated HLHS. One of the biggest challenges in palliative care of HLHS is weight gain and gastrostomy-button (GB) may be beneficial. To evaluate GB insertion during Norwood admission on increase in body mass index (BMI), height, and weight between Norwood discharge to Glenn discharge. Design/Methods: A retrospective cohort study of patients with HLHS at Cook Children's Medical Center (CCMC) between 2007 and 2021 was performed. Patients were excluded for not undergoing Norwood procedure; remaining inpatient between Norwood and Glenn procedures; having GB inserted after Norwood discharge; or not completing Glenn procedure at CCMC. Gender and GB status were recorded. Age, height, and weight were recorded for at Norwood surgery, GB Insertion, Norwood discharge, Glenn surgery and Glenn discharge. World Health Organization growth charts were used to compute age- and gender-adjusted z-scores for BMI, height, and weight. Change in growth variables were then compared between patients with and without GB using a two-tailed independent sample t-tests. Results: Of 146 patients meeting inclusion criteria, 56 patients were excluded: 3 did not undergo Norwood procedure; 21 remained inpatients between Norwood and Glenn procedures; 2 had G-Button inserted after Norwood discharge; and 30 did not complete Glenn procedure at CCMC. Of the remaining 90 patients, 31 (34%) had GB. Patients with GB gained significantly more (p=0.011) weight than patients without GB from Norwood discharge to Glenn discharge. There were no significant differences in height or BMI changes during that period (see Figure 1). Conclusion: Patients after Norwood procedure undergoing GB placement demonstrate greater weight gain than those without GB placement. The present research should be replicated using a larger sample.