Use of a Digital Monitoring Platform to Improve Outcomes in Infants With a Single Ventricle

Abstract

Background: Despite advances, infants with single ventricle heart disease continue to have high morbidity and mortality in the first year of life. Home monitoring programs (HMPs) have reduced mortality and have grown to use integrative digital platforms. The objective was to evaluate how implementation of a digital HMP platform affects nutritional outcomes in infants undergoing staged single ventricle palliation. Methods: We conducted a retrospective, multicenter, observational study of all infants who required a neonatal operation as part of staged single ventricle palliation between 2013 and 2018. Patients were excluded if less than 35 weeks’ gestation or underwent biventricular repair in the first year of life. Implementation of a digital monitoring platform that allows for secure monitoring of nasogastric feed advancement and oxygen saturation occurred in 2016, creating the two groups in a similar surgical era. Results: There were 38 patients who fell under a standard HMP compared to 31 utilizing the digital platform. There was no difference in baseline demographics, anatomy, or preoperative factors between the groups. Use of a digital platform was associated with reduced postoperative length of stay (30.1 vs 33.1 days, P = .04). More children in the digital platform monitoring group were able to achieve oral feeding at one year of age (90% vs 68%, P = .03). A total of 25% of infants went home with a nasogastric tube, all but one transitioning to full oral feeds. Conclusions: Use of a digital, fully electronic medical record (EMR)-integrated, comprehensive HMP was associated with shorter postoperative length of stay in neonates undergoing staged single ventricle palliation and allowed for higher rates of full oral feeding.

Adapting Interstage Home Monitoring with the use of Telemedicine During the COVID-19 Pandemic

“…The IHM program at our institution follows the NPC-QIC and AHA recommendations [1][2][3][4][5][6][7][8]. After comprehensive education with families is completed, our high-risk cyanotic infants are discharged home with an Apple iPad (Apple Inc., Cupertino, CA) with the Locus Health monitoring platform (Locus, Charlottesville, VA) pre-loaded.…”

“…In addition, adverse events, unplanned hospital readmissions, and unplanned procedures were recorded. Adverse events were defined as cardiac arrest, shunt thrombosis, arrhythmia, systemic infection, aspiration, stroke, or seizures as have been previously described in the literature [1][2][3][4][5][6][7][8].…”

“…Cyanotic infants, including patients with single-ventricle physiology during the interstage period are the highest risk pediatric cardiology patients. Historically prior to 2000, the post-discharge care provided after stage 1 palliation to single ventricle patients lacked the level of surveillance needed to manage these high-risk patients safely at home, with mortality reported as high as 16% during the interstage period [1][2][3][4][5][6][7][8]. There have been dramatic improvements in the outcomes of these high-risk patients over the past 10-20 years.…”

“…There have been dramatic improvements in the outcomes of these high-risk patients over the past 10-20 years. This is largely attributed to the development of effective and comprehensive interstage home monitoring (IHM) programs for these patients [1][2][3][4][5][6][7][8] and an AHA statement published in 2020 advocated for IHM programs as standard of care in this patient population [7].…”

Cardiovascular Disease Screening in Women: Leveraging Artificial Intelligence and Digital Tools

“…In complex congenital heart disease with single-ventricle physiology, digital tools for tracking weights and oxygen saturation have also been successfully used by parents to help manage these complex patients. 67,68…”