Stephanie L Siehr1, Jana K Norris1, Julie A Bushnell1, Chandra Ramamoorthy2, V Mohan Reddy3, Frank L Hanley3, Gail E Wright4. 1. Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif. 2. Department of Anesthesia, Stanford University School of Medicine, Palo Alto, Calif. 3. Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, Calif. 4. Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif. Electronic address: gewright@stanford.edu.
Abstract
BACKGROUND: From 2002 to 2005, the interstage mortality after a modified Norwood procedure was 7% in our program. An interstage home monitoring program (HMP) was established to identify Norwood procedure patients at increased risk of decompensation and to reduce interstage mortality. METHODS: Results of the first 5 years of the Norwood HMP were reviewed retrospectively. Interstage was defined as the time between Norwood hospital discharge and admission for second stage surgical palliation. In the HMP, families documented oxygen saturation, heart rate, weight, and feedings daily. Nurse practitioners called each family at least weekly, and when issues arose, action plans were determined based on symptom severity. RESULTS: Between October 2005 and October 2010 there were 46 Norwood procedure patients who survived to hospital discharge. All were enrolled in the HMP. Forty-five patients had a Norwood procedure with right ventricle to pulmonary artery conduit, and 1 patient had a modified Blalock-Taussig shunt. Interstage survival was 100%. Nineteen patients (41%) were admitted interstage; 5 patients were admitted twice, 1 patient was admitted 4 times. Seventeen patients (37%) required interstage interventions. Eight patients (17%) required major interventions: conduit stenting, aortic arch balloon angioplasty, emergent shunt, or early Glenn surgery. Minor interventions included supplemental oxygen, blood transfusion, intravenous hydration, diuresis, anti-arrhythmic therapy, or feeding adjustments. CONCLUSIONS: In the first 5 years of the HMP, all infants discharged after a modified Norwood procedure survived the interstage period. The HMP altered clinical management in 37% of patients. Home monitoring of oxygen saturation, heart rate, weight, and feedings, along with comprehensive care coordination, allowed timely interventions and reduced interstage mortality from 7% to 0%.
BACKGROUND: From 2002 to 2005, the interstage mortality after a modified Norwood procedure was 7% in our program. An interstage home monitoring program (HMP) was established to identify Norwood procedure patients at increased risk of decompensation and to reduce interstage mortality. METHODS: Results of the first 5 years of the Norwood HMP were reviewed retrospectively. Interstage was defined as the time between Norwood hospital discharge and admission for second stage surgical palliation. In the HMP, families documented oxygen saturation, heart rate, weight, and feedings daily. Nurse practitioners called each family at least weekly, and when issues arose, action plans were determined based on symptom severity. RESULTS: Between October 2005 and October 2010 there were 46 Norwood procedure patients who survived to hospital discharge. All were enrolled in the HMP. Forty-five patients had a Norwood procedure with right ventricle to pulmonary artery conduit, and 1 patient had a modified Blalock-Taussig shunt. Interstage survival was 100%. Nineteen patients (41%) were admitted interstage; 5 patients were admitted twice, 1 patient was admitted 4 times. Seventeen patients (37%) required interstage interventions. Eight patients (17%) required major interventions: conduit stenting, aortic arch balloon angioplasty, emergent shunt, or early Glenn surgery. Minor interventions included supplemental oxygen, blood transfusion, intravenous hydration, diuresis, anti-arrhythmic therapy, or feeding adjustments. CONCLUSIONS: In the first 5 years of the HMP, all infants discharged after a modified Norwood procedure survived the interstage period. The HMP altered clinical management in 37% of patients. Home monitoring of oxygen saturation, heart rate, weight, and feedings, along with comprehensive care coordination, allowed timely interventions and reduced interstage mortality from 7% to 0%.
Authors: Garick D Hill; David A Hehir; Peter J Bartz; Nancy A Rudd; Michele A Frommelt; Julie Slicker; Jena Tanem; Katherine Frontier; Qun Xiang; Tao Wang; James S Tweddell; Nancy S Ghanayem Journal: J Thorac Cardiovasc Surg Date: 2014-02-08 Impact factor: 5.209
Authors: Daniel Alexander Castellanos; Cynthia Herrington; Stacey Adler; Karen Haas; S Ram Kumar; Grace C Kung Journal: Pediatr Cardiol Date: 2016-08-23 Impact factor: 1.655
Authors: Andrew L Dailey-Schwartz; Hanna J Tadros; Mahshid Sababi Azamian; Seema R Lalani; Shaine A Morris; Hugh D Allen; Jeffrey J Kim; Andrew P Landstrom Journal: J Pediatr Date: 2018-08-29 Impact factor: 4.406
Authors: Masamichi Ono; Takashi Kido; Marie Wallner; Melchior Burri; Julia Lemmer; Peter Ewert; Martina Strbad; Julie Cleuziou; Alfred Hager; Jürgen Hörer Journal: Interact Cardiovasc Thorac Surg Date: 2021-07-26
Authors: Nancy A Rudd; Nancy S Ghanayem; Garick D Hill; Linda M Lambert; Kathleen A Mussatto; Jo Ann Nieves; Sarah Robinson; Girish Shirali; Michelle M Steltzer; Karen Uzark; Nancy A Pike Journal: J Am Heart Assoc Date: 2020-08-11 Impact factor: 5.501