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Neonatal decompensation before surgery in hypoplastic left heart syndrome: a case control study
Victoria E Sheward1, Ian A Murdoch1, Andrew Durward1
1Evelina Children's Hospital, London, UK.
Summary
Neonates with hypoplastic left heart syndrome (HLHS) at risk of decompensation show subtle increases in heart and respiratory rates prior to surgery. Monitoring these rates of change, not just absolute values, is crucial for early detection.
Area of Science:
- Pediatric Cardiology
- Neonatal Intensive Care
- Congenital Heart Disease Research
Background:
- Neonates with hypoplastic left heart syndrome (HLHS) face decompensation risks due to pulmonary overcirculation before Norwood 1 surgery.
- Systemic underperfusion is a key concern in HLHS neonates requiring surgical intervention.
Purpose of the Study:
- To investigate differences in preoperative temporal physiological and laboratory variable profiles between HLHS neonates who decompensated and those who did not.
- To identify early warning signs of decompensation in HLHS neonates prior to surgical repair.
Main Methods:
- A case-control study design was employed, analyzing data from a Paediatric Intensive Care Unit between 2002 and 2013.
- Eighty-five neonates with HLHS were matched by birth weight and admission date, with decompensation defined by the need for emergency intubation.
- Non-linear modeling using generalized estimating equations was used to analyze variable trajectories over time.
Main Results:
- Decompensation occurred around day 3 of life in cases, while controls underwent surgery around day 4.
- Oxygen saturation and blood pressure trajectories did not differ significantly between groups.
- Heart and respiratory rates increased significantly faster in neonates who decompensated compared to controls.
Conclusions:
- Subtle but significant differences in heart rate, respiratory rate, and metabolic acid-base trajectories precede decompensation in HLHS neonates.
- Evaluating the rates of change in physiological variables, rather than solely absolute values, is critical for predicting and managing preoperative decompensation in HLHS.
