Management of Neonates Admitted With Tetralogy of Fallot: Changing Patterns Across the United States

BACKGROUND This study describes the evolving in-hospital management strategies for neonates who are diagnosed with tetralogy of Fallot (ToF).METHODS The Pediatric Health Information System (PHIS) database was used to identify admitted patients aged 0 to 1 month old with ToF from 2010 through 2019; era 1, 2010 through 2014; and era 2, 2015 through 2019. International Classification of Diseases codes were used to identify related interventions that occurred during this admission but not necessarily as a neonate: full repair, systemic-to-pulmonary shunt, and percutaneous stent in the right ventricular outflow tract and/or patent ductus arteriosus.RESULTS Among 6021 neonates diagnosed with ToF, 2030 (34%) underwent an intervention: 60% had total repair, 31% systemic-to-pulmonary shunt, and 9% percutaneous stent. In the no-intervention cohort, in-hospital mortality was 9%. In-hospital mortality between repair (6%), shunt (6%), and stent (3%) patients (P = .446) did not differ. Regarding regional practices, no intervention was most frequently used in the Midwest (69% vs 65% average for all other regions [avg], P = .075) while interventions overall were performed most frequently in the West (36% vs 33.5% avg, P = .075). Among the interventions, full repair was most frequent in the Northeast (76% vs 57% avg, P < .001), shunt was most frequent in the Midwest (39% vs 28% avg, P < .001), and stent was most frequent in the South (11% vs 7% avg, P = .083). Between eras 1 and 2, the type of intervention changed: full repair (52% vs 69%, P < .001) and stent (1% vs 16%, P < .001) increased, while shunt decreased (47% vs 15%, P < .001).CONCLUSIONS Although most neonates admitted with ToF are discharged with no intervention, more than one-third undergo some intervention with a 3% to 6% mortality. The proportion of these patients who undergo an intervention is unchanged during the past decade, but the types of intervention have changed, and significant regional differences exist.(Ann Thorac Surg 2022;114:1419-26) (c) 2022 by The Society of Thoracic Surgeons

Automated summary

This study examines the evolving management strategies for neonates with tetralogy of Fallot (ToF) during their hospital stay. The study analyzed the Pediatric Health Information System (PHIS) database and identified 2030 out of 6021 neonates diagnosed with ToF who underwent interventions such as total repair, systemic-to-pulmonary shunt, and percutaneous stent. The study found that regional practices varied, with different interventions being most frequent in different regions.