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

Abstract

ABSTRACTIntroductionPoor interstage (IS) weight gain is a risk factor for adverse outcomes in infants with hypoplastic left heart syndrome (HLHS). We sought to examine the association of neighborhood social vulnerability and IS weight gain and determine if this association is modified by enrollment in our institution’s Infant Single Ventricle Management and Monitoring Program (ISVMP).MethodsWe performed a retrospective single-center study of infants with HLHS before (2007-2010) and after (2011-2020) the introduction of the ISVMP. The primary outcome was IS weight gain, and the secondary outcome was IS growth failure. Multivariable linear and logistic regression models were used to examine the association between Social Vulnerability Index (SVI) and the outcomes. We introduced an interaction term into the models to test for effect modification by ISVMP.ResultsWe evaluated 217 ISVMP infants and 111 pre-ISVMP historical controls. SVI was associated with IS growth failure (P = 0.001), however, enrollment in ISVMP strongly attenuated this association (P = 0.04). Pre-ISVMP, high and middle vulnerability infants gained 4 gm/day less and were significantly more likely to experience growth failure than low vulnerability infants (high vs. low: aOR 12.5; 95% CI 2.5-62.2; middle vs. low: aOR 7.8; 95% CI 2.0-31.2). After the introduction of the ISVMP, outcomes did not differ by SVI tertile. Middle and high SVI infants enrolled in ISVMP gained 4 gm/day and 2 gm/day more, respectively, than pre-ISVMP controls.ConclusionIn infants with HLHS, high social vulnerability is a risk factor for poor IS weight gain. However, enrollment in ISVMP significantly reduces growth disparities.