Resource Utilization Associated with Extracardiac Co-morbid Conditions Following Congenital Heart Surgery in Infancy

Tuomela, Krista; Gordon, John B.; Cassidy, Laura D.; Johaningsmeir, Sarah; Ghanayem, Nancy S.

doi:10.1007/s00246-017-1620-y

Cited by 15 publications

(7 citation statements)

References 15 publications

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“…However, a recent study highlights that overall medical costs are substantially higher for children with extra cardiac comorbid conditions. 15 Hence, identifying at-risk congenital heart disease patients and gaining a better understanding of how different modifiable factors affect neurodevelopment in infants with congenital heart disease may help develop interventions that will not only reduce the burden of overall developmental disability but may also decrease the health care costs.…”

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confidence: 99%

Superior Performance in Prone in Infants With Congenital Heart Disease Predicts an Earlier Onset of Walking

et al. 2018

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Infants with congenital heart disease are at risk of impaired neurodevelopment, which frequently manifests as motor delay during their first years of life. This delay is multifactorial in origin and environmental factors, such as a limited experience in prone, may play a role. In this study, we evaluated the motor development of a prospective cohort of 71 infants (37 males) with congenital heart disease at 4 months of age using the Alberta Infant Motor Scales (AIMS). We used regression analyses to determine whether the 4-month AIMS scores predict the ability to walk by 18 months. The influence of demographic and clinical variables was also assessed. Fifty-one infants (71.8%) were able to maintain the prone prop position (AIMS score of ≥3 in prone) at 4 months. Of those, 47 (92.2%) were able to walk by 18 months compared to only 12/20 (60%) of those who did not maintain the position. Higher AIMS scores were predictive of a greater likelihood of walking by 18 months ( P < .001), with the scores in prone having a higher predictive ability compared to those in other positions (Exp(B) 15.2 vs 4.0). Shorter hospital stays and female gender were also associated with an earlier onset of walking. In conclusion, our study demonstrates that early ventral performance in infants with congenital heart disease impacts the age of acquisition of walking and could be used to guide referral to rehabilitation.

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confidence: 99%

Superior Performance in Prone in Infants With Congenital Heart Disease Predicts an Earlier Onset of Walking

et al. 2018

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“…Many children with CHD have additional chronic medical conditions, with the rate of non‐cardiac comorbidities reported to be anywhere from 20% to 50% . Comorbid medical conditions result in increased resource utilization following hospital discharge . In our sample, infants with a history of a congenital anomalies were more likely to have received developmental interventions prior to their first clinic visit and were more likely to be referred for further interventions.…”

Section: Discussionmentioning

confidence: 91%

“…13,14 Comorbid medical conditions result in increased resource utilization following hospital discharge. 15 In our sample, infants with a history of a congenital anomalies were more likely to have received developmental interventions prior to their first clinic visit and were more likely to be referred for further PT-Occupational 9…”

Section: Discussionmentioning

confidence: 95%

Ancillary referral patterns in infants after initial assessment in a cardiac developmental outcomes clinic

Monteiro

Serrano

Tsang

et al. 2019

Congenital Heart Disease

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Objective Neurodevelopmental impairment is common after surgery for congenital heart disease (CHD) in infancy. While neurodevelopmental follow‐up of high‐risk patients has increased, the referral patterns for ancillary services following initial evaluation have not been reported. The aim of this study is to describe the rates and patterns of referral at the initial visit to our outcomes clinic of patients who underwent surgery for CHD during infancy. Outcomes Measures The Cardiac Developmental Outcomes Program clinic at Texas Children’s Hospital provides routine longitudinal follow‐up with developmental pediatricians and child psychologists for children who required surgery for CHD within the first 3 months of life. Demographic, diagnostic, and clinical data, including prior receipt of intervention and referral patterns at initial presentation, were abstracted from our database. Results Between April 2013 and May 2017, 244 infants under 12 months of age presented for initial evaluation at a mean age of 7 ± 1.3 months. At presentation, 31% (76/244) were referred for either therapeutic intervention (early intervention or private therapies), ancillary medical services, or both. Referral rates for low‐risk (STAT 1‐3) and high‐risk (STAT 4‐5) infants were similar (28 vs. 33%, P = .48). Referrals were more common in: Hispanic white infants (P = .012), infants with non‐cardiac congenital anomalies (P = .001), history of gastrostomy tube placement (P < .001), and infants with prior therapy (P = .043). Infants of non‐English speaking parents were three times more likely to be referred (95% CI = 1.5, 6.4; P = .002). Conclusions At the time of presentation, nearly 1 in 3 infants required referral. Referral patterns did not vary by traditional risk stratification. Sociodemographic factors and co‐morbid medical conditions increased the likelihood of referral. This supports the need for routine follow‐up for all post‐surgical infants regardless of level of surgical complexity. Further research into the completion of referrals and long‐term referral patterns is needed.

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“…Tuomela and colleagues studied non-cardiac comorbidities in infants with CHD and the impact on resource utilization. (17) They found non-cardiac comorbidities occurred in 55% of infants. Most commonly observed were gastrointestinal (the need for enteral tube feeds, malrotation), respiratory (vocal cord dysfunction, airway malacia) and genetic diseases (Trisomy 21 and DiGeorge syndrome).…”

Section: The Cost Of Chdmentioning

confidence: 99%

Selected 2018 Highlights in Congenital Cardiac Anesthesia

Nasr

Gottlieb

Adler

et al. 2019

Journal of Cardiothoracic and Vascular Anesthesia

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This article is a review of the highlights of pertinent literature published during the 12 months of 2017, which is of interest to the congenital cardiac anesthesiologist. Following a search of the US National Library of Medicine PubMed database, several topics emerged where significant contributions were made in 2017, and that the authors of this manuscript felt were noteworthy to be summarized in this review: Training in pediatric cardiac anesthesia, the costs of congenital heart disease (CHD), catheter versus surgical intervention for CHD, cerebral oxygen saturation in CHD, and mechanical circulatory support in children. Training in pediatric cardiac anesthesia In 2004, the Accreditation Council for Graduate Medical Education (ACGME) Next Accreditation system was implemented with the creation of milestones to all specialties.(1) Since 2007, for surgeons who operate on patients with CHD ranging from neonates to adults, a subspecialty certification in congenital cardiac surgery is granted following completion of a one-year accredited residency and passing of a written examination and an oral examination.(2) The number of accredited surgical programs in the US has increased from 2 in 2006 to 12, and the number of graduates has increased from 2 in 2008 to 44 in 2014.(3,4) Along with the increase in structured training for congenital cardiac surgery, there has been an increase in the need of physicians with advanced knowledge and experience in pediatric cardiac intensive care. Several informal advanced training pathways have been suggested following surgical, anesthesia or intensive care trainings and were discussed at the 10 th International Conference of the Pediatric Cardiac Intensive Care Society.(5) Similarly to surgical and intensive care specialties, pediatric cardiac anesthesiology has evolved as a subspecialty devoted to patients with CHD ranging from neonates to adults. While there is a consensus on the need to define standards for the pediatric cardiac anesthesia fellowship, there remains a wide variability in duration of training and clinical experience. Different training pathways have been proposed in the past few years and several recent publications are highlighted to outline the proposed future pathways. In Germany, a working group representing the German Society for Anesthesiology and Intensive Care surveyed all pediatric cardiac centers with the intent to define "expertise in pediatric cardiac anesthesia".(6) Twenty-seven centers with an active pediatric cardiac surgery program participated in the survey with a response rate of 96.3%. The suggested length of training in pediatric cardiac anesthesia was 12-months in 42.3% of centers with a mean of 10.8-months to achieve sufficient experience. However, the length of training may not be reflective of the competence of the trainee.(7) Because, different learners with different knowledge or experience backgrounds progress at different rates, the time needed by a trainee to achieve competence may vary.(8,9) Recently, based on the ACGME Milestones Model...

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Resource Utilization Associated with Extracardiac Co-morbid Conditions Following Congenital Heart Surgery in Infancy

Cited by 15 publications

References 15 publications

Superior Performance in Prone in Infants With Congenital Heart Disease Predicts an Earlier Onset of Walking

Superior Performance in Prone in Infants With Congenital Heart Disease Predicts an Earlier Onset of Walking

Ancillary referral patterns in infants after initial assessment in a cardiac developmental outcomes clinic

Selected 2018 Highlights in Congenital Cardiac Anesthesia

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