title: Cavopulmonary Anastomosis During Same Hospitalization as Stage 1 Norwood/Hybrid Palliative Surgery.
abstract: BACKGROUND
  Limited literature has examined characteristics of infants with hypoplastic left heart syndrome (HLHS) who remain hospitalized during the interstage period. We described their epidemiologic characteristics, in-hospital outcomes, and identified risk factors that predict the need for superior cavopulmonary anastomosis (SCPA) during the same hospitalization.
  
  
  METHODS
  This retrospective multicenter database analysis included infants with HLHS who underwent stage 1 palliation from 2004 through 2013.
  
  
  RESULTS
  Among 5374 infants with HLHS, 314 (5.8%) underwent SCPA during the same hospitalization as stage 1 palliation. They had a higher incidence of baseline comorbidities, complications, and interventions than infants who were discharged. Despite an overall increase in need for SCPA in the same hospitalization across different eras, there was no significant statistical difference in mortality in the two groups in the same era. Septicemia, necrotizing enterocolitis, modified Blalock-Taussig shunt, cardiac catheterization, cardiopulmonary resuscitation, extracorporeal membrane oxygenation, gastrostomy tube, and antiarrhythmic agents were independently associated with increased odds of undergoing SCPA during the same hospitalization. Patients undergoing right ventricle to pulmonary artery shunt were less likely to remain hospitalized until stage 2 palliation. Nonsurvivors in the SCPA group had greater need for interventions and worse intensive care unit outcomes.
  
  
  CONCLUSIONS
  Infants with HLHS who remain hospitalized after stage 1 until their stage 2 palliation differ significantly from infants who were discharged. Several clinical characteristics, comorbidities, and need for interventions are associated with the likelihood for undergoing stage 2 palliation during the same hospitalization. Timely identification and intervention of adjustable causes of heart failure may improve outcomes.
authors.affiliation: Pediatric Cardiology, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee; Pediatric Critical Care, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee. Electronic address: stadphal@uthsc.edu.
authors.forename: Sachin D
authors.initials: SD
authors.lastname: Tadphale
authors.affiliation: Department of Biostatistics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors.forename: Xinyu
authors.initials: X
authors.lastname: Tang
authors.affiliation: Department of Neonatology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors.forename: Nahed O
authors.initials: NO
authors.lastname: ElHassan
authors.affiliation: Department of Pediatric Cardiology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors.forename: Brandon
authors.initials: B
authors.lastname: Beam
authors.affiliation: Department of Pediatric Cardiology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas; Department of Pediatric Critical Care, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors.forename: Parthak
authors.initials: P
authors.lastname: Prodhan
mesh_terms: D005260:Female; D018610:Heart Bypass, Right; D006760:Hospitalization; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D058327:Norwood Procedures; D010166:Palliative Care; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome