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Impact of Home Monitoring Program and Early Gastrostomy Tube on Interstage Outcomes following Stage 1 Norwood Palliation

Abstract

Nutritional management and home monitoring programs (HMPs) may be beneficial for improving interstage morbidity and mortality following stage I Norwood palliation (S1P) for hypoplastic left heart syndrome (HLHS). We recognized an increasing trend towards early feeding gastrostomy tube (GT) placement prior to discharge in our institution, and we aimed to investigate the effect of HMPs and GTs on interstage mortality and growth parameters. Single-institutional review at a tertiary referral center between 2008 and 2018. Individual patient charts were reviewed in the electronic medical record. Those listed for transplant or hybrid procedures were excluded. Baseline demographics, operative details, and interstage outcomes were analyzed in GT and non-GT patients (nGT). Our HMP was instituted in 2009, and patients were analyzed by era: I (early, 2008–2012), II (intermediate, 2013–2016), and III (recent, 2017–2018). 79 patients were included in the study: 29 nGTs and 50 GTs. GTs had higher number of preoperative risk factors more S1P complications, longer ventilation times, longer lengths of stay, and shorter times to readmission. There were no differences in interstage mortality or overall mortality between groups. There was one readmission for a GT-related issue with no periprocedural complications in the group. Weight gain doubled after GT placement in the interstage period while waiting periods for placement decreased across Eras. HMPs and early GTs, especially for patients with high-risk features, provide a dependable mode of nutritional support to optimize somatic growth following S1P.

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Fig. 1

Data Availability

All data were freely available to all investigators and co-authors.

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Commercially available software was used.

Abbreviations

ECMO:

Extracorporeal membrane oxygenation

GT:

Gastrostomy tube

HMP:

Home-monitoring program

HLHS:

Hypoplastic left heart syndrome

IQR:

Interquartile range

LOS:

Length of stay

NG:

Nasogastric

nGT:

No gastrostomy tube

POD:

Postoperative day

SD:

Standard deviation

S1P:

Stage 1 Norwood palliation

S2P:

Stage 2 palliation

VIS:

Vasoactive-inotropic Score

WAZ:

Weight-for-age z-score

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Acknowledgements

The authors wish to acknowledge the Riley Clinical Data and Outcomes Center assistance with data collection and statistical analysis.

Funding

No external funding was used for this study.

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Authors

Contributions

CRM, DH, AGF, JLH: Study design. CRM, KZ, CLC: Data acquisition and analysis. Manuscript preparation: All co-authors.

Corresponding author

Correspondence to Jeremy L. Herrmann.

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All authors declare that they have no conflict of interest.

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Institutional Review Board approval was obtained.

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Patient consent was waived due to the retrospective nature of the study.

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Matthews, C.R., Hartman, D., Farrell, A.G. et al. Impact of Home Monitoring Program and Early Gastrostomy Tube on Interstage Outcomes following Stage 1 Norwood Palliation. Pediatr Cardiol (2022). https://doi.org/10.1007/s00246-022-02947-4

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  • DOI: https://doi.org/10.1007/s00246-022-02947-4

Keywords

  • Single ventricle physiology
  • Gastrostomy tube feeding
  • Interstage outcomes