86 - Can Pre-Discharge Oxygen Saturation Metrics Predict Interstage Interval Following Single Ventricle Palliation in Infants with Hypoplastic Left Heart Syndrome?

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 86
Publication Number: 86.425

Theiju Sebastian, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Nimrod Goldshtrom, Columbia University Irving Medical Center, New York, NY, United States; Joseph R.. Isler, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Rakesh Sahni, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States

Presenting Author(s)

Theiju Sebastian, MD (she/her/hers)

Fellow
Columbia University Vagelos College of Physicians and Surgeons
New York, New York, United States

Background: Children with hypoplastic left heart syndrome (HLHS), undergo a series of staged surgical procedures for balancing blood flow to the pulmonary and systemic circulations. Despite improvements in survival, there is still significant interstage mortality between the first stage (Norwood) and second stage (Glenn) palliation (S2P), and the optimal surgical timing still remains unclear. Pre-discharge oxygen saturation metrics derived from continuous oxygen saturation (SpO₂) monitoring with pulse oximetry following Norwood procedure may influence inter-stage interval and aid in predicting timing for S2P.

Objective: To compare pre-discharge oxygen saturation metrics and interstage interval in infants with HLHS undergoing early (postnatal age ≤180 days) versus late (postnatal age >180 days) Glenn following initial Norwood procedure.

Design/Methods: We performed a retrospective observational study in infants admitted to Cardiac NICU at Morgan Stanley Children’s Hospital between Dec 2012 and Apr 2015 with HLHS who underwent initial Norwood and subsequent Glenn procedures. Artifact free continuous pulse oximetry data obtained from NICU physiological database (collected every 2-seconds for the entire hospitalization) was utilized to derive 72-hr pre-discharge oxygen saturation metrics that included median (IQR) SpO₂ and percent time spent in oxygen saturation ranges of < 65%, 65-69%, 70-74%, 75-79%, 80-85% and >85%. Oxygen saturation metrics and interstage interval were then compared in infants who subsequently underwent early (≤180 days) versus late ( >180 days) Glenn procedure using t-test.

Results:

Pre-discharge oxygen saturation metrics following Norwood were available for 26 infants who subsequently underwent early (n=18) or late (n=8) Glenn procedure. There were no differences in gestational age (38.4±1.6 vs. 38.3±1.4 weeks; p=0.77) and postmenstrual age at discharge following Norwood (43.1±2.6 vs. 43.1±2.2 weeks; p=0.98) between the two groups. Table 1 displays the group differences in interstage interval and various 72-hr pre-discharge oxygen saturation metrics.

Conclusion(s): Infants with HLHS who underwent earlier S2P exhibit lower pre-discharge oxygen saturation metrics following Norwood procedure than those requiring later Glenn surgery. Pre-discharge oxygen saturation metrics obtained from continuous pulse oximetry following Norwood can be used to help predict timing for S2P and potentially reduce interstage mortality.