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Published on: April 19, 2019
Single-ventricle infant home monitoring programs: outcomes and impact
David A Hehir1, Nancy S Ghanayem
1Division of Pediatric Cardiology, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA. dhehir@mcw.edu
Insights
Home monitoring programs significantly reduce interstage mortality in infants with single-ventricle physiology. These enhanced surveillance strategies improve survival and growth for high-risk neonates.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Neonatal Care
Background:
- Infants with single-ventricle physiology and shunt-dependent circulation face high interstage mortality risks.
- Parallel circulation in these patients presents inherent physiological instability.
- Improving interstage outcomes is a critical focus in single-ventricle heart disease management.
Purpose of the Study:
- To review the impact of interstage home monitoring programs on outcomes for infants with single-ventricle physiology.
- To highlight the role of enhanced surveillance in reducing mortality.
- To discuss the potential of home monitoring as a collaborative care model.
Main Methods:
- Review of multi-institutional trials and single-center series on interstage monitoring.
- Analysis of data from the Pediatric Heart Network Single-Ventricle Reconstruction Trial.
- Examination of quality improvement initiatives and pilot projects using new technologies.
Main Results:
- Interstage mortality in the Pediatric Heart Network trial was 12%.
- Single-center studies demonstrate significant survival and growth benefits from interstage monitoring.
- Quality improvement collaboratives aim to identify high-risk patients and establish best practices.
Conclusions:
- Interstage home monitoring programs represent a successful collaborative care model.
- Ongoing research will refine home monitoring elements and improve patient outcomes.
- This model offers a template for managing other medically complex infant populations.
Purpose Of Review:
Patients with single-ventricle, shunt-dependent physiology are at increased risk for interstage death due to the inherent instability of parallel circulation. Enhanced surveillance and early identification of deteriorating physiology via interstage home monitoring result in significant reduction in mortality. These programs are an important focus of improving outcomes for patients with single-ventricle heart disease.
Recent Findings:
In the multi-institutional Pediatric Heart Network Single-Ventricle Reconstruction Trial, interstage mortality was 12%, highlighting the continued opportunity to improve on this metric. A number of single-center series have demonstrated significant benefit of interstage monitoring on survival and growth. The focus on interstage monitoring by the National Pediatric Cardiology Quality Improvement Collaborative of the Joint Council on Congenital Heart Disease should improve our understanding of patients at greatest risk and help establish best practices for interstage care. In addition, a number of pilot projects utilizing newer communication technologies seek to improve the connection between program and patient.
Summary:
Interstage home monitoring programs are a model of collaborative care that improves outcomes. Continued research in this area will refine the elements of home monitoring programs and continue to guide improved results. In addition, this model may serve as a template for the care of other populations of medically complex infants.
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