Somatic Growth In Children With Single Ventricle Physiology:Impact Of Physiologic State

? Objective ? To analyse somatic growth pattern of children undergoing Fontan procedure,furthermore to investigate its influencing factors related to growth.In addition,the differences in intestinal microbiota between children with single ventricle and bi-ventricle were analyzed,thus,to discover characteristics of intestinal flora in children with single ventricle.?Methods? Children who underwent Fontan procedure were followed up in part one.The weight and height of those children were evaluated in each surgical stage and followed up after Fontan surgery,also the pattern of growth was described.Children who completed the follow-up in part one were enrolled into part two.The risk factors for malnutrition in children after Fontan were discussed by univariate and multivariate logistic regression analysis.In part three,19 cases of single-ventricle children with 20 cases bi-ventricle children were enrolled for microbiota research.The differences in the diversity and composition of gut microbiota were compared between those two groups.?Results? Children who underwent stage one Fontan procedure,weight for age Z-score(WAZ)and height for age Z-score(HAZ)before Fontan were lower than those at birth(P < 0.05).Children who underwent stage two Fontan procedure,WAZ and HAZ before Glenn were lower than those at birth and before Fontan(P < 0.05),and HAZ in the follow-up period was higher than those before Fontan(P < 0.05).Children who underwent stage three Fontan procedure,WAZ before systemic to pulmonary shunt or pulmonary artery banding was lower than those at birth(P <0.05),WAZ before Fontan was higher than those before Glenn(P < 0.05).In the follow-up survey after Fontan procedure,the proportion of underweight,thinness and stunting were 11.9%,16.9%,17.8%,respectively.Multivariate logistic regression analysis showed that preoperative malnutrition,worsening cardiac function,long time use of diuretics,elevated pulmonary artery pressure and atrioventricular valve regurgitation were the risk factors of malnutrition after Fontan procedure.In the fecal samples of single-ventricle children,the abundance of the bacterial genera Veillonella and Bilophila were higher than that of bi-ventricle children(P< 0.05),the abundance of the bacterial genera Faecalibacterium,Lachnoclostridium and Roseburia were lower than that of bi-ventricle children(P< 0.05).? Conclusions ? The somatic growth is impaired in children undergoing different stage of Fontan procedure.Growth nadir appeared before operation,and began to catch up with growth after the operation.However,malnutrition was still remained during follow-up period after Fontan procedure.Children who have preoperative malnutrition,worsening cardiac function,elevated pulmonary artery pressure,long time use of diuretics and atrioventricular valve regurgitation were more likely to suffer from malnutrition after Fontan procedure.The structure of intestinal microbiota of single-ventricle children in some of the specific bacteria had changed compared with bi-ventricle children.The abundance of the bacterial genera Veillonella was significantly increased,and the abundance of the bacterial genera Faecalibacterium and Roseburia were significantly decreased in children with single ventricle physiology.And those changes may aggravate the intestinal inflammation of the single-ventricle children.