Abstract 18761: High Mortality In Infants With Ebstein'S Anomaly Who Undergo Conservative Management: A Multicenter Study
Introduction: Neonates with symptomatic Ebstein's anomaly often require various types of intervention to increase pulmonary blood flow. Previous reports have noted that conservative management (non-surgical and non-interventional catheterization based) has a low mortality (6%). No large-scale studies describe the outcomes of neonates who undergo conservative management for Ebstein's anomaly in the current era.
Hypothesis/Purpose: To determine mortality outcomes of neonates admitted to pediatric hospitals with the diagnosis of Ebstein's anomaly that undergo conservative management.
Methods: A retrospective cohort study from January 2003 to December 2007 of neonates admitted with the diagnosis of Ebstein's anomaly to 41 pediatric hospitals was performed. We utilized the Pediatric Health Information System (PHIS) database to identify patients, race, sex, extra corporeal membrane oxygenation (ECMO) use, nitric oxide (iNO) use, prostaglandin use, length of stay (LOS), and in-hospital mortality. Statistical differences were assessed by the Mann-Whitney U and Chi square tests.
Results: A total of 257 neonates admitted with Ebstein's anomaly underwent conservative management. One hundred and twenty four were female. Overall mortality was 56/257 (21.8%) composed of 34 (60.7%) female and 22 (39.3%) male patients (p=0.035). The median LOS was 10 days [interquartile range, IQR, 20]. Survivors had a median LOS of 12 days [IQR 19] and non-survivors median LOS was 5 days [IQR 18] (p<0.001). Mortality was 12.5% (n=16) in African-Americans, 23.3% (n= 176) in Caucasians, 37.5% (n=8) in Asians, and 17.5% (n=57) in other; these differences were not significant p>0.05. ECMO, prostaglandins and iNO were used in 6, 137 and 59 patients respectively without affecting mortality significantly (p>0.05)
Conclusion: In contrast to previous reports, analysis of a large-scale database demonstrates that conservative management of symptomatic neonates with Ebstein's anomaly had a high mortality rate. Mortality was significantly higher in female patients. Race, ECMO, prostaglandin and iNO use did not significantly affect mortality. Length of stay was significantly shorter in non-survivors. A more aggressive management for these patients may be warranted.
- © 2010 by American Heart Association, Inc.