Abstract
Background and Aims
Prior to first stage palliation, impaired systemic perfusion puts neonates with hypoplastic left heart syndrome (HLHS) at risk for hemodynamic decompensation. The aim of this study was to assess whether decompensation may be preceded by specific patterns in their vital parameters.
Methods
In this retrospective cohort study, all neonates with HLHS admitted to the Pediatric Intensive Care Unit of the University Medical Center Utrecht between 2009-2019 were included. Mortality or the need to delay surgery were chosen as endpoints for hemodynamic decompensation. The course of heart and respiratory rate, oxygen saturation and invasive blood pressure was visualized in the 48 hours prior to clinical interventions (intubation, initiation of inotropic therapy and placement of central venous or arterial catheter) and mixed effects modelling were used to compare between decompensated and non-decompensated patients.
Results
Of 46 patients, nine (20%) decompensated of whom five (11%) died prior to surgery. Figure 1 shows the course of vital parameters in one non-decompensated and three decompensated patients. Decompensated infants showed statistically significant differences in the course of heart rate (p=0.007) and respiratory rate (p<0.001) prior to inotropic therapy and heart rate (p=0.012) and respiratory rate (p=0.030) prior to placement of a catheter.
Conclusions
Subtle but significant differences exist in the course of vital parameters between decompensated and non-decompensated neonates with HLHS prior to first stage palliation. Implementation of reference values of these vital parameters for this critical population in monitoring and patient data management systems might support clinicians in recognizing decompensation early on.
Prior to first stage palliation, impaired systemic perfusion puts neonates with hypoplastic left heart syndrome (HLHS) at risk for hemodynamic decompensation. The aim of this study was to assess whether decompensation may be preceded by specific patterns in their vital parameters.
Methods
In this retrospective cohort study, all neonates with HLHS admitted to the Pediatric Intensive Care Unit of the University Medical Center Utrecht between 2009-2019 were included. Mortality or the need to delay surgery were chosen as endpoints for hemodynamic decompensation. The course of heart and respiratory rate, oxygen saturation and invasive blood pressure was visualized in the 48 hours prior to clinical interventions (intubation, initiation of inotropic therapy and placement of central venous or arterial catheter) and mixed effects modelling were used to compare between decompensated and non-decompensated patients.
Results
Of 46 patients, nine (20%) decompensated of whom five (11%) died prior to surgery. Figure 1 shows the course of vital parameters in one non-decompensated and three decompensated patients. Decompensated infants showed statistically significant differences in the course of heart rate (p=0.007) and respiratory rate (p<0.001) prior to inotropic therapy and heart rate (p=0.012) and respiratory rate (p=0.030) prior to placement of a catheter.
Conclusions
Subtle but significant differences exist in the course of vital parameters between decompensated and non-decompensated neonates with HLHS prior to first stage palliation. Implementation of reference values of these vital parameters for this critical population in monitoring and patient data management systems might support clinicians in recognizing decompensation early on.
| Original language | English |
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| Publication status | Published - 15 Jun 2021 |
| Event | The European Society of Paediatric and Neonatal Intensive Care Congress: An Online Xperience - Duration: 15 Jun 2021 → 18 Jun 2021 https://espnic2021.kenes.com/scientific-programme/ |
Conference
| Conference | The European Society of Paediatric and Neonatal Intensive Care Congress |
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| Abbreviated title | ESPNIC 2021 |
| Period | 15/06/21 → 18/06/21 |
| Internet address |