Home surveillance program prevents interstage mortality after the Norwood procedure. J Thorac Cardiovasc Surg 2003 Nov;126(5):1367-77
Date
12/11/2003Pubmed ID
14666008DOI
10.1016/s0022-5223(03)00071-0Scopus ID
2-s2.0-10744232526 (requires institutional sign-in at Scopus site) 315 CitationsAbstract
OBJECTIVE: To determine whether early identification of physiologic variances associated with interstage death would reduce mortality, we developed a home surveillance program.
METHODS: Patients discharged before initiation of home surveillance (group A, n = 63) were compared with patients discharged with an infant scale and pulse oximeter (group B, n = 24). Parents maintained a daily log of weight and arterial oxygen saturation according to pulse oximetry and were instructed to contact their physician in case of an arterial oxygen saturation less than 70% according to pulse oximetry, an acute weight loss of more than 30 g in 24 hours, or failure to gain at least 20 g during a 3-day period.
RESULTS: Interstage mortality among infants surviving to discharge was 15.8% (n = 9/57) in group A and 0% (n = 0/24) in group B (P =.039). Surveillance criteria were breached for 13 of 24 group B patients: 12 patients with decreased arterial oxygen saturation according to pulse oximetry with or without poor weight gain and 1 patient with poor weight gain alone. These 13 patients underwent bidirectional superior cavopulmonary connection (stage 2 palliation) at an earlier age, 3.7 +/- 1.1 months of age versus 5.2 +/- 2.0 months for patients with an uncomplicated interstage course (P =.028). A growth curve was generated and showed reduced growth velocity between 4 and 5 months of age, with a plateau in growth beyond 5 months of age.
CONCLUSION: Daily home surveillance of arterial oxygen saturation according to pulse oximetry and weight selected patients at increased risk of interstage death, permitting timely intervention, primarily with early stage 2 palliation, and was associated with improved interstage survival. Diminished growth identified 4 to 5 months after the Norwood procedure brings into question the value of delaying stage 2 palliation beyond 5 months of age.
Author List
Ghanayem NS, Hoffman GM, Mussatto KA, Cava JR, Frommelt PC, Rudd NA, Steltzer MM, Bevandic SM, Frisbee SS, Jaquiss RD, Litwin SB, Tweddell JSAuthors
Joseph R. Cava MD, PhD Associate Professor in the Pediatrics department at Medical College of WisconsinPeter C. Frommelt MD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin
George M. Hoffman MD Chief, Professor in the Anesthesiology department at Medical College of Wisconsin
Kathleen Mussatto Ph.D. Associate Professor in the School of Nursing department at Milwaukee School of Engineering
Nancy A. Rudd RN APP Inpatient 1 in the Pediatrics department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Cardiac Surgical ProceduresContinuity of Patient Care
Female
Home Care Services, Hospital-Based
Hospitals, Pediatric
Humans
Hypoplastic Left Heart Syndrome
Infant
Infant, Newborn
Male
Monitoring, Physiologic
Oximetry
Oxygen
Patient Discharge
Probability
Program Development
Reference Values
Risk Assessment
Risk Management
Survival Analysis
Survival Rate
Time Factors
Wisconsin
