CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
275
Background:
The REMEDY study is a comprehensive, contempo-
rary data collection on patients with rheumatic heart disease (RHD).
It is a hospital-based international registry in progress, involving
20 sites in Africa and India. This abstract focuses on the patients
enrolled at Groote Schuur Hospital (GSH) in Cape Town.
Methods:
Over a two-year period, 420 patients with RHD were inter-
viewed and enrolled into the REMEDY study from the cardiac clinic
out-patients department at GSH. At enrolment, demographic data,
clinical findings, treatment practises, ECG and echocardiographic
details were recorded onto structured record forms.
Results:
Among a study population of 420 patients, 52% of the
patients were in the age group 30 to 50 years. Eight per cent were
severely debilitated in their daily functioning (NYHA III and IV).
According to the patients’ past medical history, 6% have had major
bleeding, 19% stroke, 19% valvuloplasty and 66% valve surgery. A
total of 44.7% had been prescribed oral anticoagulation therapy. Of
concern was the finding that 40% of patients had two or fewer INR
measures in the previous six months, while only 4% had monthly
INR checks. In addition, 62% did not know what their goal INR
should be. Only 14% of patients had been prescribed secondary
prophylaxis, although 66% have had surgery.
Conclusion:
These preliminary results highlight the need to improve
the knowledge of both health practitioners and patients with regard
to treatment practices.
1312: A PILOT STUDY OF A SKIN-TO-SKIN CARE INTER-
VENTION IN INFANTS WITH CONGENITAL HEART
DEFECTS
Tondi Harrison
1
, Roger Brown
2
1
Nationwide Children’s Hospital and The Ohio State University, USA
2
University of Wisconsin, Madison, USA
Aim:
Infants born with complex congenital heart defects (CCHD)
demonstrate impaired parasympathetic nervous system function.
Early separation impairs infant parasympathetic function, and
newborn infants with CCHD and their mothers are often physically
separated due to the infants’ need for intensive care. Skin-to-skin
contact (SSC) is effective in improving infant parasympathetic func-
tion in other high-risk infant populations. This study examined the
feasibility, acceptability and safety of an intervention designed to
enhance infant parasympathetic function through daily SSC between
mothers and newborn infants with CCHD.
Methods
: Ten infants with CCHD and their mothers were recruited.
Mothers provided at least one hour of SSC for 14 consecutive days
post-operatively, shortly after initiation of nipple feedings. Feasibility
and acceptability were measured with a survey and mothers’ written
records of duration and frequency of holding. Safety was measured
by infants’ cardiorespiratory stability during SSC. Measures of
parasympathetic function, as indexed by high-frequency heart rate
variability (HF-HRV), were collected at feedings before and after the
intervention and bi-weekly for four weeks.
Results
: Mothers provided a daily mean of 66.58 (SD
=
4.85) minutes
in SSC over the 14-day intervention. Mothers were positive in their
evaluation of SSC, and no adverse events occurred. Improvements
in parasympathetic function over time were demonstrated with (1)
developmentally appropriate increases in the magnitude of baseline
(pre-feeding) HF-HRV (
t
=
40.01,
p
<
0.001), (2) consistent improve-
ments in time to post-feeding HF-HRV recovery, as calculated using
event history analysis, and (3) gradual permanent improvements in
adaptive parasympathetic responses to feeding in six of 10 infants, as
calculated using ARIMA time-series analysis.
Conclusions
: SSC is a safe, feasible and acceptable intervention for
infants treated for CCHD as neonates. Improved parasympathetic
responses to feeding were demonstrated. A randomised clinical trial
is needed to more closely examine the effects of SSC on parasym-
pathetic function.
1439: FREQUENT ADVERSE EVENTS IN INFANTS WITH
SINGLE-VENTRICLE ANATOMY DURING THE INTER-
STAGE PERIOD
Patricia O’Brien, Margaret Schroeder, Sarah Sinclair, Sonia Handa,
Jean Connor, Michelle Steltzer
Boston Children’s Hospital, USA
Background
: Infants with single-ventricle anatomy s/p post stage
1 repair or those with shunt-dependent lesions are at continued risk
for morbidity and mortality during the inter-stage period. Home
monitoring programmes (HMP) were developed to detect worsen-
ing oxygen saturations, dehydration and growth failure. This study
reviews inter-stage adverse events in infants followed in a HMP.
Methods
: This was a single-centre retrospective review of 53 infants
with single-ventricle anatomy who were in a HMP during the inter-
stage period (time from initial discharge to Glenn procedure) over a
two-year period, 2009 to 2011. Inter-stage adverse events (changes
in oxygen saturation, poor feeding or poor weight gain, inter-current
illness and other health problems) were evaluated.
Results
: There were 32 infants with HLHS (60%) and 21 infants with
other types of single-ventricle anatomy; inter-stage mortality was
5.5%. The average inter-stage period was 119 days. There were 145
adverse events; 50 for changes in saturation, 46 for poor feeding or
inadequate weight gain, 29 for inter-current illnesses (bacterial and
viral infections) and 19 for numerous other health problems. While
not specifically targeted on HMP, infections and other medical prob-
lems comprised 33% of events. Management involved ER evaluation
for 17 events, and 73 hospital admissions. There were 33 unexpected
catheterisations or surgical procedures. Eight patients (15%) had no
adverse events; only two patients with HLHS had no events. Eleven
patients (21%) had more than five events. Of the nine patients with
naso-gastric (NG) or gastric (G)-tube feedings, all had one or more
adverse events. Nine patients (17%) needed prolonged hospital care.
Conclusion
: HMP detected many adverse inter-stage events of vary-
ing aetiologies, which were frequent and often required hospitalisa-
tion. A third of the adverse events involved inter-current illnesses or
other medical problems. Patients with NG or G-tube feeds and those
with HLHS were more likely to have adverse events.
1466: CHARACTERISTICS OF POST-OPERATIVE CARDI-
AC SURGICAL PATIENTS READMITTED TO THE PAEDI-
ATRIC INTENSIVE CARE UNIT
Rebecca Tracey
ICU, Royal Children’s Hospital, Melbourne, Australia
Background:
The paediatric intensive care unit (PICU) is a 20-bed
integrated general and surgical unit within a university-affiliated
tertiary children’s hospital. The hospital performs approximately
700 cardiac surgical procedures per year, providing comprehensive
care for the treatment of neonates, infants, children and young adults
with complex congenital cardiac lesions. The PICU Liaison Program
was developed in 2005 to facilitate discharge, and support patients
and families on the wards. In an effort to reduce readmission rates
to PICU, the Liaison Nurse team developed a risk-management
tool known as the Clinical Marker Score (CMS). It is used to iden-
tify predictive risk factors for readmission during the discharge and
follow-up process. The tool is a combination of both objective and
subjective score components derived from a case–control regression
analysis of PICU discharge and readmission data. It is a generic tool
used on PICU patient populations both prior to discharge and on
every follow-up visit by the liaison nurse.
Aim:
To test the hypothesis that predictors of readmission will vary
across the general and cardiac surgical patient population in the
PICU. The purpose of this study was to describe the characteristics
of cardiac surgical patients readmitted to the PICU.
Methods:
This was a retrospective review of all postoperative
cardiac surgical patients readmitted to the PICU within 72 hours of
discharge. The data period was between January 2005 and June 2012.
No interventions were performed in this study.
