Abstract 10463: Neighborhood Social Vulnerability and Interstage Weight Gain: Evaluating the Role of a Home Monitoring Program

Abstract

Introduction: Interstage (IS) growth failure is a risk factor for poor outcomes in infants with hypoplastic left heart syndrome (HLHS). We hypothesize that children with greater social vulnerability are at greater risk for IS growth failure. However, IS home monitoring may mitigate disparities in IS weight gain. We sought to examine the impact of an Infant Single Ventricle Management and Monitoring Program (ISVMP) on the association of neighborhood social vulnerability and IS weight gain. Methods: We performed a retrospective single-center cohort study of infants with HLHS before (2007-2010) and after (2011-2020) the introduction of the ISVMP. IS weight gain was measured in grams per day (gm/day) and growth failure was defined as an average IS weight gain of <20 gm/day. Neighborhood social vulnerability was measured by the Centers for Disease Control Social Vulnerability Index (SVI) with higher SVI values representing greater vulnerability. Linear and logistic regression models were used to examine the association between SVI and IS weight gain and growth failure. Models were adjusted for demographic, operative, and discharge characteristics. To test for effect modification by ISVMP, we introduced an interaction term into the models and calculated pre- and post- stratum-specific effect estimates. Results: In total, 328 infants with HLHS, were evaluated 111 before and 217 after the introduction of the ISVMP. In the total cohort, SVI was significantly associated with IS growth failure (P= 0.001). Enrollment in ISVMP strongly attenuated the association of SVI and IS growth failure (P = 0.04). Prior to ISVMP, infants in the highest and middle SVI tertiles gained 4 gm/day less than infants in the lowest SVI tertile and were more likely to experience IS growth failure (high vs. low: aOR 12.5; 95% CI 2.5-62.2; middle vs. low: aOR 7.8; 95% CI 2.0-31.2). However, after the introduction of the ISVMP, there was no difference in IS weight gain or growth failure by SVI tertile. Middle and high SVI infants enrolled in ISVMP gained 4 gm/day and 2 gm/day more than their pre-ISVMP counterparts, respectively. Conclusion: High social vulnerability is a risk factor for poor IS weight gain in infants with HLHS. However, enrollment in ISVMP significantly reduces growth disparities.