Role of Home Monitoring in Reducing Disparities in the Interstage Mortality of Infants with Single Ventricle

To determine whether the interstage (between Norwood and stage 2 palliation) home monitoring program (IHMP) has reduced disparities in interstage survival and growth outcomes in patients with single-ventricle heart disease.

A single-center, retrospective study was performed on patients with single-ventricle lesions who underwent a Norwood operation between January 2000 and December 2020. Data were collected from the institutional electronic medical record, the Pediatric Cardiac Critical Care Consortium and National Pediatric Cardiology Quality Improvement Collaborative registries, and the US census. The National Pediatric Cardiology Quality Improvement Collaborative's NEONATE risk score was used as the representative clinical variable. Primary outcomes were interstage mortality (ISM) and interstage growth (ISG), assessed by change in weight-for-age z scores. Multivariable logistic and linear regressions were used to examine the impact of IHMP, initiated in 2012 to address clinical and sociodemographic contributors of ISM, on the independent associations of patient clinical and sociodemographic factors with ISM and ISG, respectively.

Post-IHMP, ISM decreased (12.7% vs 6.7%, P = .04) and average ISG z scores increased (-0.15 [0.97] vs 0.14 [0.84)] P = .01). Multivariable analyses showed that lower birth weight, public insurance, and high NEONATE risk score were independently associated with ISM (all P < .05). Birth weight, feeding at discharge, and NEONATE risk score were independently associated with ISG (all P < .05). Both results remained significant after adjusting for IHMP.

In the current era, with a robust IHMP, ISG and ISM improved whereas sociodemographic disparities persisted, suggesting the need for a tailored approach for vulnerable patient groups.