• 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, and J S Tweddell.
• Department of Pediatrics, and National Outcomes Center, Inc, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, 53226, USA. nghanayem@aol.com
• J. Thorac. Cardiovasc. Surg. 2003 Nov 1; 126 (5): 1367-77.

ObjectiveTo determine whether early identification of physiologic variances associated with interstage death would reduce mortality, we developed a home surveillance program.MethodsPatients 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.ResultsInterstage 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.ConclusionDaily 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.

33 keywords...

hide…