Home surveillance program prevents interstage mortality after the Norwood procedure

The Journal of Thoracic and Cardiovascular Surgery
N S GhanayemJ S Tweddell

Abstract

To determine whether early identification of physiologic variances associated with interstage death would reduce mortality, we developed a home surveillance program. 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. 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 interstag...Continue Reading

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Citations

Dec 24, 2005·Pediatric Cardiology·J M SimsicA M Atz
Sep 14, 2007·Pediatric Cardiology·William N EvansAbraham Rothman
Apr 25, 2012·Pediatric Cardiology·David A HehirNancy S Ghanayem
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