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Purpose Dapagliflozin recently received FDA-approval for use in adults with heart failure with reduced ejection fraction to reduce the risk of cardiovascular death and hospitalization for heart failure (HF). This is the first report describing safety and use of dapagliflozin in children with HF. Methods This is a single-center, observational, retrospective analysis assessing safety of dapagliflozin when added to a background of guideline-directed medical therapy in 9 pediatric patients (age Results Median age was 14.2 years (IQR 11.2-17.7; range 9-18). Of the 9 patients, 6 had dilated cardiomyopathy, 2 had single ventricle physiology, and 1 had diastolic HF. NYHA functional class was as follows: 6 were class II, 2 were class III, and 1 was class IV. Median baseline hemoglobin A1c was 5.5% (IQR 5.3-5.75). Most (78%) were started on dapagliflozin during a HF-related hospitalization. Median starting dose of dapagliflozin was 5 mg once daily (IQR 5-10). Mean follow-up was 30.6 days (SD 21.6). Median dose at follow-up was 10 mg once daily (IQR 7.5-10). Urine glucose was negative at baseline and 1+ to 3+ at follow-up confirming the pharmacodynamic effect of dapagliflozin. Total daily dose of loop diuretic was decreased 50% for 3 patients at follow-up. There were no significant differences in weight, blood pressure, heart rate, ejection fraction, B-type natriuretic peptide, estimated glomerular filtration rate or blood chemistries at follow-up. No adverse events such as urinary tract infections, hypoglycemia, fractures, hypovolemia or renal injury were observed. Dapagliflozin was discontinued in 1 patient due to receipt of a heart transplant. Conclusion Dapagliflozin appears to be safe in the short term when added to guideline-directed medical therapy for children with heart failure.

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Objective The study objective was to evaluate risk factors for poor weight gain in infants with hypoplastic left heart syndrome after stage 1 palliation. Methods We reviewed all term infants with hypoplastic left heart syndrome who had stage 1 palliation and stage 2 palliation at Texas Children's Hospital between 2000 and 2011 (n = 120). Predictor variables included age at stage 1 palliation, intensive care unit factors, calories delivered, and echocardiographic findings. Outcome variables included weight for age Z scores at hospital discharge, stage 2 palliation, and change in weight for age Z scores between stage 1 palliation and hospital discharge. Results Complete nutritional data were available for 47 of 120 patients. Median total parenteral nutrition duration was 6 days (range, 1-43 days), and median intensive care unit calories delivered was 53.9 kcal/kg/d (range, 22.3-119.6 kcal/kg/d). Before hospital discharge, the median caloric intake was 106.7 kcal/kg/d (range, 70.0-152.0 kcal/kg/d). Median weight for age Z scores was −0.59 (range, −3.6 to 0.5) at stage 1 palliation, −1.62 (range, −4.5 to −0.1) at intensive care unit transfer, and −1.81 (range, −4.9 to −0.5) at hospital discharge. A total of 46 of 47 patients had a negative change in weight for age Z scores between stage 1 palliation and hospital discharge, with a median change of −1.14 (range, −2.3 to 0.6). Change in weight for age Z scores from stage 1 palliation to discharge was directly associated with calories delivered and indirectly associated with hospital length of stay and moderate tricuspid regurgitation ( P Conclusions Postoperative nutrition fails to meet the needs of infants with hypoplastic left heart syndrome despite increased focus on nutritional support. Modifiable factors (eg, nutritional intake) and hemodynamic factors (eg, tricuspid regurgitation) may play roles in the poor weight gain of these infants.

transplant (HTx) recipients is unknown. Our study assessed the prevalence of BKV infection and its association with renal dysfunction in pediatric HTx recipients. Methods: We conducted a single center retrospective cohort study on all pediatric HTx recipients (aged < 18) who received a HTx between May 1989 and July 2013 who are currently followed at our center and had BKV testing. Since April 2012, urine BKV loads have been checked in all patients at time of annual evaluation, and prior to that, in patients with chronic kidney disease or acute kidney dysfunction. Serum BK viremia was assayed in patients with positive BK viruria. Data collected included demographics, donor information, immunosuppression regimen, and history of viral illnesses. Descriptive statistics, Fisher’s exact analysis, and Student’s T-test were done to compare patients with and without BK viruria (controls). Results: Of 100 eligible HTx recipients, 51 have been screened to date. Seventeen (33%) of these had BK viruria, and 4 (8%) developed viremia. One viremic patient (2%) progressed to BKV nephropathy diagnosed by biopsy, and required a renal transplant for end stage renal disease. Increasing mean urine viral load was significantly associated with progression from BK viruria (2.1x10^8 copies/mL) to viremia (22.2x10^8 copies/mL) (p= 0.01). History of positive EBV serologies (p= 0.01), use of Sirolimus immunosuppression (p= 0.0006), and duration of time since HTx (6.42 years vs. 3.84 years; p= 0.04) were significantly associated with BK viruria. Renal function, in terms of Schwartz CKiD eGFR, was not significantly different between patients with BK viruria and controls (74.2 vs. 79.8 mL/min per 1.73 m^2, p= 0.41). Conclusion: Increasing mean urine BK viral load, time since HTx, evidence of past EBV infection, and use of Sirolimus were associated with BKV. A prospective study is planned to assess the incidence of BKV in HTx recipients. Routine screening of the urine BK viral load should be considered in this population.