Interstage Home Monitoring for Infants With Single Ventricle Heart Disease

Rudd NA, Ghanayem NS, Hill GD, et al.
Interstage Home Monitoring for Infants With Single Ventricle Heart Disease: Education and Management: A Scientific Statement From the American Heart Association. J Am Heart Assoc 2020;9:e014548.

The following are key points to remember from this American Heart Association scientific statement related to home monitoring in infants with single ventricle heart disease:

  1. The interstage period has been defined as the time of discharge from the initial palliative procedure to the time of second stage palliation for infants with shunt-dependent single ventricle heart disease.
  2. Historically, the interstage period has been associated with mortality rates as high as 16%.
  3. Interstage home monitoring (IHM) programs consist of in-home surveillance strategies to detect physiologic changes that may precede hemodynamic decompensation or collapse.
  4. Parameters monitored as part of IHM programs include in-home use of pulse oximetry and the use of infant scales to detect weight loss. Additional metrics include heart rate trends, oral intake, and additional signs and symptoms of cardiac or noncardiac illness.
  5. Caregiver education is an important component of a home monitoring program. Caregivers require training in equipment use, recording, and interpreting data. Caregiver education should begin early in the hospitalization. Ideally, more than one caregiver should be trained.
  6. A coordinated discharge process transitioning to the IHM program team is the interstage medical home. The discharge process should include a conference call, which includes the following components of interstage care:
    • Review of hospital course and interventions
    • Introduction of IHM team and management plan
    • Discussion of appointments including those with primary cardiologist, primary care physician, specialists, therapies, neurodevelopmental clinic, and future cardiac procedures or tests
    • Emergency plan
    • Caregiver/family resources and support groups
  7. The following have been identified as common “red flags” for interstage monitoring:
    • Oxygen saturation ≤75%
    • Failure to gain 20 g in 3 days
    • Weight loss ≥30 g
    • Enteral intake <100 ml/kg per day
    • Cyanosis/pallor
    • Irritable/fussy
    • Diarrhea or vomiting
    • Increased sweating
    • Tachypnea or respiratory distress
    • Temperature >100.4°F
  8. Programs participating in the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) reported interstage mortality as low as 2%. The NPC-QIC reported a decrease in interstage mortality by >40% between 2008 and 2016. Additionally, use of a nutrition bundle was associated with a 28% reduction in interstage growth failure.

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and CHD and Pediatrics, Congenital Heart Disease, CHD and Pediatrics and Interventions, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Interventions and Structural Heart Disease

Keywords: Cardiac Surgical Procedures, Caregivers, Heart Defects, Congenital, Hemodynamics, Infant, Monitoring, Physiologic, Palliative Care, Patient Discharge, Pediatrics, Physicians, Primary Care, Quality Improvement, Respiratory Distress Syndrome, Newborn, Tachypnea, Weight Loss

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