Home monitoring program benefits children after Norwood palliation

Perspective from Therese M. Giglia, MD, FACC, FAAP, SCCM

CHICAGO — Use of an interdisciplinary single-ventricle task force team employing home monitoring in the care of children with congenital heart disease after Norwood palliation was associated with a reduction in complications and improved weight, researchers reported.

The researchers measured the clinical outcomes of stage II admission and gauged the approval of parents and cardiologists. The study population was divided into two cohorts, one with Norwood surgery dates before the development of the single-ventricle task force (pre-SVTF) and one interventional cohort (post-SVTF). Post-SVTF data included surveys from parents and cardiologists on the effectiveness of the program.

The results were presented at the American College of Cardiology Scientific Session and published in Pediatric Cardiology.

Compared with the pre-SVTF group, the post-SVTF group experienced fewer complications after stage II (18.4% vs. 34.1%; P = .02) and had higher weight for-age z scores at stage II (–1.5 plus or minus 0.97 vs. –1.58 plus or minus 1.34; P = .02). In addition, a written red-flag action plan given to parents at the time of Norwood discharge was independently associated with higher weight at stage II (β = 0.42; P = .04) and higher weight for-age z score (β = 0.48; P = .02)

“Parents encouraged expansion of the team approach to cover all children with congenital heart disease,” Ashraf Harahsheh, MD, from Children’s National Health System, Washington, D.C., and colleagues wrote in the paper and the abstract. “There was approval within the larger group of cardiologists for the development of a subspecialized task force to care for the complex [single-ventricle] patient population.” – by Tracey Romero

References:

Harahsheh A, et al. Poster 1109-198. Presented at: American College of Cardiology Scientific Session; April 2-4, 2016; Chicago.

Harahsheh A, et al. Pediatr Cardiol. 2016;doi:10.1007/s00246-016-1366-y.

Disclosure: Harahsheh reports no relevant financial disclosures.

Perspective

Therese M. Giglia, MD, FACC, FAAP, SCCM

These findings, as well as other reports utilizing data from the National Pediatric Cardiology-Quality Improvement Collaborative (NPC-QIC), will have a significant impact on care of this fragile group of patients. Like Children’s National Health System, Children’s Hospital of Philadelphia is a member of NPC-QIC and also has a robust infant single ventricle monitoring program with a dedicated nurse practitioner, five attending cardiologists as well as parent advisors. We are currently in the process of analyzing our institutional data and anticipate improvements when compared with pre-program controls.

Hypoplastic left heart syndrome remains a disease with high morbidity and mortality. Individual institutions working with the NPC-QIC have a real chance of making a significant impact on the lives of these infants and children.

Therese M. Giglia, MD, FACC, FAAP, SCCM

Attending cardiologist and Medical Director

Infant Single Ventricle Monitoring Program

The Children’s Hospital of Philadelphia

Disclosures: Giglia reports no relevant financial disclosures.