Interstage home monitoring of infants after heart defect surgery reduces mortality
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Interstage home monitoring programs for babies who underwent surgery due to heart defects reduced infant mortality by approximately 40%, according to a scientific statement from the American Heart Association.
These programs educated family caregivers on how to monitor key parameters including feeding, growth and oxygen levels after initial surgeries for left heart syndrome and other single ventricle heart diseases.
“Transition home can be a stressful time for families after an admission for a complex surgery like the Norwood operation,” Nancy A. Rudd, MS, CPNP-PC/AC, nurse coordinator for the interstage home monitoring program at Herma Heart Institute at Children’s Wisconsin, nurse practitioner in the division of pediatric cardiology at the Medical College of Wisconsin, Milwaukee, and chair of the statement writing committee, told Healio. “Interstage home monitoring programs not only offer enhanced in-home surveillance of these at-risk infants but also bridge the gap from parents having a health care team constantly available inpatient to suddenly, following discharge, parents assuming all the responsibility of managing their infant’s basic needs and medical needs.”
The first home monitoring program was launched at Children’s Wisconsin in 2000 after findings from the National Pediatric Cardiology Quality Improvement Collaborative network indicated that trends for infant mortality were as high as 16% during the interstage period after initial heart surgeries, according to an AHA press release.
After the adoption of new interstage home monitoring programs at 50 centers between 2008 and 2016, investigators observed that the average mortality rate dropped approximately 40% across the U.S., with an additional 28% improvement in infant weight gain.
“Prior to interstage home monitoring programs, the outpatient management of interstage infants was the same as that of much less complex patients,” Rudd said in the release. “Unfortunately, the tenuous nature of these infants means they can get very sick very quickly from even minor childhood illness like the common cold.”
Designed to reduce infant mortality, the interstage home monitoring programs educated family caregivers to identify key “red flag” warning signs that should immediately be brought to the attention of the infant’s care team. These warning signs included:
- oxygen saturation less than 75%;
- failure to gain 0.02 kg in 3 days;
- weight loss of 0.03 kg or more;
- enteral intake of less than 100 mL/kg per day;
- cyanosis or pallor;
- irritable or fussy;
- diarrhea or vomiting;
- increased sweating;
- respiratory changes such as tachypnea or distress; and
- temperature of more than 100.4°F.
“The physiologic monitoring requires an infant scale to follow weight trends and a portable pulse oximeter for tracking of oxygen saturations and heart rate — and some means of tracking this data along with feedings. This can be done with a paper binder or a digital health app on a phone or iPad,” Rudd said in an interview. “But just collecting these data parameters won’t make a new program work unless there is a dedicated team of providers (NPs, cardiologists, nurses, others) who are committed to being available to these patient and families 24/7. Not only to check the data and watch for concerns but most importantly to support families and listen to and address any concerns or needs they may have.”
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