title: Improving interstage survival after Norwood operation: outcomes from 10 years of home monitoring.
abstract: OBJECTIVE
  Infants who undergo Norwood stage 1 palliation (S1P) continue with high-risk circulation until stage 2 palliation (S2P). Routine care during the interstage period is associated with 10% to 20% mortality. This report illustrates the sustained reduction of interstage mortality over 10 years associated with use of home monitoring.
  
  
  METHODS
  Daily monitoring of oxygen saturation and weight was done for all patients discharged to home after S1P. Notification of the care team occurred for oxygen saturation<75% or >90%, weight gain<20 g over 3 days, weight loss>30 g, or intake<100 cc/kg/d. Breach of these criteria marked an interstage event. Interstage outcomes are reported. Patient characteristics and perioperative variables were compared between patients with and without interstage events.
  
  
  RESULTS
  Over 10 years, 157 patients were discharged after S1P with home monitoring. Interstage survival was 98%. Breach of home criteria occurred in 59% (93 out of 157), with violation of oxygen saturation<75% the most common event. Patient characteristics, operative data, and early postoperative morbidity did not differ between patients with and without events.
  
  
  CONCLUSIONS
  Home monitoring after S1P is associated with excellent interstage survival. Although a breach of monitoring criteria occurred in more than half of patients, our analysis failed to identify independent predictors of interstage events. Analysis of variables predicting mortality could not be assessed due to the low frequency of death in this cohort. Failure to identify specific variables for interstage events suggests that home monitoring, as part of an interstage surveillance program, should be applied to all S1P hospital survivors.
authors.affiliation: Section of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis; Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wis. Electronic address: nrudd@chw.org.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Rudd
authors.affiliation: Section of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis; Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wis.
authors.forename: Michele A
authors.initials: MA
authors.lastname: Frommelt
authors.affiliation: Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wis; Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wis.
authors.forename: James S
authors.initials: JS
authors.lastname: Tweddell
authors.affiliation: Section of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis; Section of Critical Care, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis; Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wis.
authors.forename: David A
authors.initials: DA
authors.lastname: Hehir
authors.affiliation: Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wis.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Mussatto
authors.affiliation: Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wis.
authors.forename: Katherine D
authors.initials: KD
authors.lastname: Frontier
authors.affiliation: Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wis.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Slicker
authors.affiliation: Section of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis; Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wis.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Bartz
authors.affiliation: Section of Critical Care, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis; Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wis.
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Ghanayem
mesh_terms: D002149:Energy Intake; D005260:Female; D018575:Home Care Services, Hospital-Based; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000401:mortality / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018670:Monitoring, Ambulatory / Q000379:methods*; D058327:Norwood Procedures / Q000401:mortality; D010092:Oximetry; D010100:Oxygen / Q000097:blood; D010166:Palliative Care; D058996:Quality Improvement; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D015430:Weight Gain
chemical_list: D010100:Oxygen