Document Detail

Home surveillance program prevents interstage mortality after the Norwood procedure.
MedLine Citation:
PMID:  14666008     Owner:  NLM     Status:  MEDLINE    
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.
N S Ghanayem; G M Hoffman; K A Mussatto; J R Cava; P C Frommelt; N A Rudd; M M Steltzer; S M Bevandic; S S Frisbee; R D B Jaquiss; S B Litwin; J S Tweddell
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  126     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2003 Nov 
Date Detail:
Created Date:  2003-12-10     Completed Date:  2004-01-14     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1367-77     Citation Subset:  AIM; IM    
Department of Pediatrics, and National Outcomes Center, Inc, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, 53226, USA.
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MeSH Terms
Cardiac Surgical Procedures / methods*,  mortality*
Continuity of Patient Care*
Home Care Services, Hospital-Based*
Hospitals, Pediatric
Hypoplastic Left Heart Syndrome / mortality*,  surgery*
Infant, Newborn
Monitoring, Physiologic / methods*
Oxygen / blood*
Patient Discharge
Program Development
Reference Values
Risk Assessment
Risk Management
Survival Analysis
Survival Rate
Time Factors
Wisconsin / epidemiology
Reg. No./Substance:
Comment In:
J Thorac Cardiovasc Surg. 2003 Nov;126(5):1257-8   [PMID:  14665991 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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