Impact of anatomic complexity of congenital heart disease on growth retardation: a large retrospective cohort study

Abstract

Background Growth retardation (GR) is a significant comorbidity in children with congenital heart disease (CHD), particularly those with complex CHD. This study aimed to characterize the growth patterns of pediatric CHD patients and to identify the factors associated with GR. Methods This retrospective cohort study included CHD patients aged ≤18 years from the First Hospital of Hebei Medical University between January 2014 and March 2024. Patients were classified into complex or non-complex CHD groups based on echocardiographic diagnoses. Clinical, laboratory, and echocardiographic parameters were compared. Independent factors associated with GR were identified and used to construct a nomogram for identifying the likelihood of existing GR. Results A total of 2,784 patients were included (260 with complex CHD and 2,524 with non-complex CHD). Patients with complex CHD had higher prevalence of growth impairment than those with non-complex CHD. GR (35.4% vs. 16.0%), short stature (30.0% vs. 15.1%), and underweight (27.3% vs. 13.4%) were more common in complex CHD than in non-complex CHD patients. Complex CHD, younger age, presence of pulmonary arterial hypertension, and hypoalbuminemia were identified as independent factors associated with GR. A nomogram incorporating these factors demonstrated performance in screening for prevalent GR, with an area under the receiver operating characteristic curve of 0.75 in the temporal validation cohort. Conclusions The prevalence of GR is high in children with CHD, especially among those with complex CHD. Our findings highlight the necessity of integrating routine growth surveillance into the standard of care for this population. The nomogram facilitates the identification of children with a high probability of GR, enabling timely intervention.