Physical Growth Trajectories in Children With Congenital Heart Disease: A Nationwide Study

Figures

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  Figure 1. Flow diagram of the study. CHD = congenital heart disease. *1:4 age- and sex-matched random sampling with any CHD (simple, moderate, and complex) and those without CHD. †If the growth measurements obtained at age four were unavailable, data obtained at age three were used. ‡If growth measurements obtained at age six were unavailable, data obtained at age five were used.

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  Figure 2. The profile of growth measurements over time and the incidence of poor growth outcomes of CHD groups. (A) Box-and-whisker plot presenting height Z-score. (B) Box-and-whisker plot presenting BMI Z-score. (C) Incidence of short stature. (D) Incidence of FTT. For the box-and-whisker plots, the horizontal line located inside the box indicates the median, and the lower and upper lines indicate Q1 and Q3, respectively. Cohen’s d value for each CHD group was calculated and compared with without CHD group. BMI = body mass index; CHD = congenital heart disease, FTT = failure to thrive. *p<0.001.

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  Figure 3. Height and weight growth curves of the children with CHD. (A) Height trajectory for boys. (B) Height trajectory for girls. (C) Weight trajectory for boys. (D) Weight trajectory for girls. Plots were fitted with generalized additive models using R software. The gray lines represent +1SD, 0SD, and −1SD from the 2017 Korean National Growth Charts. CHD = congenital heart disease; SDS = standard deviation score.

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  Figure 4. Generalized estimating equation analysis of the association between growth Z-scores and CHD. Growth measurements (height, weight, HC, and BMI) were obtained from annual NHSPIC check-up data and converted to Z-scores using the LMS method and the Korean National Growth Charts (KNGC2017). The filled circles represent beta estimates, whereas the error bars indicate 95% confidence intervals. The yellow circles represent the simple CHD group, the pink circles represent the moderate CHD group, and the blue circles represent the complex CHD group. Model 1 was adjusted for sex, socioeconomic status, residence, and preterm birth. Model 2 was adjusted for maternal GDM, pregnancy-induced hypertension, and type of delivery. BMI = body mass index; BMIAZ = body mass index-for-age Z-scores; CHD = congenital heart disease; GDM = gestational diabetes mellitus; HAZ = height-for-age Z-scores; HCAZ = head circumference-for-age Z-scores; NHSPIC = the National Health Screening Program for Infants and Children; WAZ = weight-for-age Z-scores.