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Advancing Care for Infants with Hypoplastic Left Heart Syndrome: New Insights into Maternal and Community Health Factors

Advancing Care for Infants with Hypoplastic Left Heart Syndrome: New Insights into Maternal and Community Health Factors 1024 537 Pam Georgiana

Nationwide Children’s Heart Center explores the impact of maternal and social determinants of health on congenital heart disease.

While maternal-fetal environment factors are known to impact outcomes in babies who receive the traditional Norwood surgery to treat hypoplastic left heart syndrome (HLHS), there is little research on how the maternal-fetal environment affects outcomes after the hybrid procedure. A team led by Erin Nealon Hehr, MD, a cardiologist at The Heart Center at Nationwide Children’s, studied a large cohort of infants with this specific congenital heart defect who received the hybrid procedure from January 2009 to August 2021. The results were published in Pediatric Cardiology.

The Heart Center at Nationwide Children’s Hospital pioneered the less-invasive hybrid procedure to replace the Norwood surgery. The hybrid procedure combines both an interventional catheterization-based and surgical approach. Nationwide Children’s is one of just a few pediatric hospitals that perform the hybrid procedure in the majority of infants with HLHS.

“As the director of the single ventricle program, I’m interested in learning more about hypoplastic left heart syndrome so we can be more effective in caring for our patients,” says Karen M. Texter, MD, who is also the director of fetal cardiology at The Heart Center at Nationwide Children’s. “In this study, we wanted to know if certain variables related to the pregnancy are associated with a higher mortality risk when using the hybrid procedure.”

The research team found that maternal health factors, including maternal diabetes, high blood pressure, obesity, smoking, drug use, or older age, did not impact the survival of infants who received the hybrid procedure. However, babies who were born prematurely or were small for their gestational age did correlate to more instances of mortality. Importantly, higher state and national area deprivation index scores were tied to a higher risk of death. This means that infants born in communities deprived of access to health care and with other social determinants of health had a greater risk of mortality.

“Our results showed meaningful risk factors for mortality in hypoplastic left heart syndrome after the hybrid Stage I procedure were related to pregnancy outcomes and health equity indices. This is similar to prior research on outcomes following the Norwood procedure,” explains Dr. Texter, who is also a clinical associate professor of pediatrics at The Ohio State University College of Medicine.

The study found that, regardless of the surgical approach, pregnancy outcomes of gestational age and low birthweight remain important risk factors for mortality in infants with HLHS. These risk factors are potentially modifiable with improvements in maternal health, starting in the pre-pregnancy period and continuing throughout the duration of the pregnancy. Improving maternal health and the maternal-fetal environment, along with broader community health access, are critical factors in improving outcomes. Dr. Texter recommends that all perinatal health providers partner with obstetricians, community health providers, maternal-fetal medicine specialists, and other pediatric subspecialists when caring for patients with pregnancies complicated by severe congenital heart disease

 “The important takeaway here is that health equity plays a role in babies surviving hypoplastic left heart syndrome long before they are born,” Dr. Texter says. “Our study on congenital heart disease is just one example of how health equity impacts us all. Improving health care access for everyone can lead to better outcomes for children.”

 

 

Reference:

Nealon E, Phelps C, Krawczeski C, Alexander R, Stiver C, Ball MK, Carrillo SA, Texter K. Impact of Maternal-Fetal Environment on Outcomes Following the Hybrid Procedure in the Single Ventricle Population. Pediatric Cardiology. 2024;45(6):1258-1266.

Image credit: Adobe Stock

About the author

Pam Georgiana is a brand marketing professional and writer located in Bexley, Ohio. She believes that words bind us together as humans and that the best stories remind us of our humanity. She specialized in telling engaging stories for healthcare, B2B services, and nonprofits using classic storytelling techniques. Pam has earned an MBA in Marketing from Capital University in Columbus, Ohio.

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