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Am J Perinatol 2024; 41(16): 2308-2311
DOI: 10.1055/s-0044-1787009
Short Communication

Critical Organ Dysfunction and Preoperative Mortality in Newborns with Hypoplastic Left Heart Syndrome

Matthew D. Durbin
1   Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
,
James L. Wynn
2   Department of Pediatrics, University of Florida, Gainesville, Florida
,
Paulomi Chaudhry
1   Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
,
Alyx Posorske
1   Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
,
Ellen Voskoboynik
1   Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
,
Woo Y. Park
4   Department of General Internal Medicine, Biomedical Informatics and Data Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Orlyn Lavilla
3   Department of Pediatrics, University of Florida, Jacksonville, Florida
,
Khyzer B. Aziz
4   Department of General Internal Medicine, Biomedical Informatics and Data Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
5   Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract

Hypoplastic left heart syndrome (HLHS) is fatal without surgical intervention. An important subset of HLHS patients die prior to surgical intervention, but this population is underevaluated. The neonatal sequential organ failure assessment score (nSOFA) is an operational definition of organ dysfunction that can identify those with a high risk of mortality among neonatal intensive care unit (NICU) patients. The utility of the nSOFA to predict preoperative mortality in the unique HLHS population is unknown and could inform care, particularly care provided by neonatology staff. We performed a multicenter retrospective cohort study of HLHS cases across three level IV NICUs from January 1, 2009, to December 3, 2023. Patients were classified as either survived or died prior to surgical intervention. Demographic variables were curated from medical records including the maximum nSOFA (nSOFAmax) before surgical intervention or death. We identified 265 patients with HLHS over the study period. The nSOFAmax was greater in patients who died preoperatively (14/265; 5%) compared with survivors to surgical intervention (median 8 [interquartile range, 6, 12] vs. 2 [0, 4]; p < 0.001). The area under receiver operating characteristics curve for the nSOFAmax to discriminate for mortality was 0.93 (95% confidence interval, 0.88–0.98; p < 0.001). Compared with an nSOFAmax of 0, the likelihood ratio for preoperative death doubled at 2, tripled at 4, and was 10-fold at 9. This is the first demonstration of nSOFA utility in specific to congenital heart disease and HLHS. The nSOFAmax represents a novel, electronic health record-compatible, and generalizable method to identify patient-level organ dysfunction and risk for preoperative mortality in HLHS patients.

Key Points

  • An important subset of HLHS patients die preoperatively.

  • nSOFA can be used to measure preoperative HLHS severity.

  • nSOFA predicts preoperative mortality risk in HLHS patients.

Keywords

congenital heart disease - hypoplastic left heart syndrome - illness severity score - nSOFA score


Publication History

Received: 08 March 2024

Accepted: 24 April 2024

Article published online:
13 May 2024

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