Sats on newborn after Norwood procedure

[crb613, BSN, RN]

OK....a baby that was born with Hypoplastic Left Heart Syndrome underwent Norwood procedure.....released home, sats staying in the 77-low 80's range family stated this is her normal. Instructed to use o2 if sats went below 70, ....to all you nurses that deal with this on a daily basis.....does this sound right?

[NotReady4PrimeTime, RN]

This is absolutely normal for this population. They continue to have mixing of oxygenated and deoxygenated blood across their Sano or BT shunt so their sats will not be "normal". The usual desired range is 75-85 and certainly no higher than 90. Hyper-oxygenation for these kids will cause right-to-left shunting, decreased cardiac output, poor perfusion and potentially death. After the second stage, the Glenn shunt, their sats will continue to run in the 70s to 80s; this could even continue after the third stage if their Fontan circulation is fenestrated - a pop-off valve to allow for more gradual adjustment to the pressure changes that occur with this procedure. They adapt very well to the lower sats by increasing their H&H. Does this help?

[crb613, BSN, RN]

Thank you for the great explanation! :yeah:With my limited knowledge my thinking was on the right path.....that

because of the mixing of the oxygenated and deoxygenated blood sats would need to be lower. I just wasn't sure how low. I had not had time to really read up/understand this in great detail. Once again thank you!....thats why I love allnurses!

[NotReady4PrimeTime, RN]

You're welcome! (This is why I love AN too!) I've been working with these kids for 9 years and have seen the good, the bad and the ugly of HLHS. (And lots of it is ugly. )

These images show you the changes made to the heart to allow survival with single ventricle physiology. the first image shows the Norwood-Sano which is the most common technique used today. This surgery is typically done in the first week of life. Recent developments have resulted in a hybrid Norwood procedure that involves banding of both pulmonary arteries, stenting of the ductus arteriosus and transcatheter balloon atrial septostomy. Some centres are gung-ho for the hybrid and some, like ours, aren't. Second is the Glenn, typically done around 5-8 months of age. The last image is the final stage (the heart in the diagram appears to be a pulmonary atresia rather than HLHS but the procedure is virtually identical); the fenestration I referred to is the opening between the SVC and the RA. Sometimes it will close on its own and sometimes it's closed with an Amplatzer septal occluder device. This surgery is usually done between 2 and 4 years of age.

These kids are quite fragile and many of them don't survive childhood. Even those who receive cardiac transplantation early tend not to do well in the long run. It's devastating.

[crb613, BSN, RN]

Awesome images! Thank you so much!