Author + information
- David W. Brown,
- Pat O'Brien,
- Katie E. Cohen,
- Matthew Glynn,
- Terry Saia,
- Kimberlee Gauvreau,
- David Fulton,
- Frank Pigula and
- Kathy Jenkins
Dedicated home monitoring programs for infants with single ventricle heart disease (SVD) in the interstage (IS) period between first and second stage palliation are becoming standard of care due to reports of improved somatic growth and IS survival; however, the impact of such programs on resource utilization is unknown.
We performed a retrospective review of two infant cohorts with SVD who underwent Stage 1 palliation (S1P) at Boston Children's Hospital and were discharged to home in 2007–2009 without an IS program (Group 1, n=65), or in 2010–2012 (Group 2, n=50) with an IS program that included home monitoring and a standardized clinical assessment and management plan (SCAMP). Clinical course through bi-directional Glenn (BDG) was compared.
Baseline characteristics were similar, including anatomy (78% hypoplastic left heart syndrome), gestational age (39 weeks), birthweight (3.2 kg), genetic anomalies (9%), pre-operative risk factors (34%), type of S1P, and post-S1P complications (75%). At discharge, age (30 days), 02 saturation (83%), weight/age z score (−1.7) were similar, but all oral feeding was more common in Group 2 (77% vs 89%, p=0.04). Total IS days did not differ (118 vs 123, p=0.85), although at BDG Group 1 had lower 02 (76% vs 80%, p=0.01) and trend toward younger age (152 vs. 171 days, p=0.10). Median number of clinic visits (4), ≥ 1ED visits (36%), and ≥1 unplanned readmissions (37%) did not differ; among those readmitted, the fraction of IS days spent hospitalized trended larger in Group 1. Group 2 had improved IS weight gain (20 vs 23 g/day, p=0.02), larger weight at BDG (6.0 vs 6.2 kg, p=0.02), and trend toward improved weight/age Z scores at BDG (−1.9 vs. −1.3, p=0.09). More required IS cardiac reoperation in Group 1 (10% vs 0%, p=0.03); unplanned interventional catheterizations were similar (31% vs 44%, p=0.67). There were fewer IS deaths in Group 2 (8 vs. 4), though not statistically significant (p=0.76). BDG outcomes were similar.
Infants with SVD followed by an IS SCAMP including home monitoring had improved rates of oral feeding and somatic growth with no increase in inpatient resource utilization, and a reduction in some measures such as reoperation.
Moderated Poster Contributions
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Congenital Cardiology Solutions: Quality and Outcomes
Abstract Category: 13. Congenital Cardiology Solutions: Pediatric
Presentation Number: 1120M-140
- 2013 American College of Cardiology Foundation