Stenting of the right ventricular outflow tract in the symptomatic infant with tetralogy of Fallot.

BACKGROUND: Repair of neonatal tetralogy of Fallot (TOF) has low mortality. Debate continues regarding the initial management of cyanotic or duct-dependent infants with TOF and adverse risk factors. While repair can and has been performed in these patients, it is associated with increased morbidity. OBJECTIVE: We review the effectiveness of right ventricular outflow tract (RVOT) stenting in the symptomatic young infant with TOF. METHODS: Clinical, echocardiographic, angiographic and haemodynamic data were reviewed for nine patients who underwent 11 RVOT stenting procedures from October 1994 to August 2007. RESULTS: The pulmonary valve was deemed unsalvageable in all patients (median valve diameter 3.7 mm (range 2.7-4.2), Z-score -6.7 (range -9.7 to -5.4). RVOT stenting improved arterial oxygen saturation from a median of 73% (60-85%) to 94% (90-98%) (p = 0.008). Median Z-score for the left pulmonary artery increased from -4.9 (-7.8 to -2.4) before stent implantation to -1.5 (-4.2 to -0.2) (p = 0.02) before surgical repair. Median Z-score for the right pulmonary artery increased from -3.7 (-6.8 to -1.9) to -0.8 (-2.5 to 0.1) (p = 0.008). Median Nakata index increased from 56 mm(2)/m(2) (21-77) to 150 mm(2)/m(2) (123-231) (p = 0.008). There were no procedural complications. Six patients have undergone successful repair. There were no deaths. CONCLUSIONS: In the symptomatic young infant with TOF, stenting of the RVOT provides a safe and effective management strategy, improving arterial oxygen saturation and encouraging pulmonary artery growth.

[Clinical risk index for small premature infants]. / Klinisk risikoindeks for små premature.

BACKGROUND: The clinical risk index for babies (CRIB) is a score given to extremely small prematures as a tool for expressing initial sickness. It was developed in order to compare results among different neonatal intensive care units (NICUs). MATERIAL AND METHODS: The CRIB score was determined for prematures with birth weight < or = 1,000 g born at the Central Hospital in Akershus during the 1995-99 period. The results are measured as the survival rate until discharge. RESULTS: 45 babies where treated at our NICU during this five-year period. Median gestation age was 27 weeks (range: 23-32 weeks), median birth weight was 875 g (range: 475-1,000 g), median CRIB was 4 (range: 1-16). The survival rate until discharge was 89%. To validate the CRIB score as a predictor for hospital mortality, a receiver-operating curve (ROC) was constructed. The area under the ROC curve was 0.93. INTERPRETATION: CRIB proved to be a good predictor for hospital mortality and seems a useful indicator for initial sickness.

The use of CRIB (clinical risk index for babies) score in auditing the performance of one neonatal intensive care unit.

The CRIB (clinical risk index of babies) score was developed to overcome the disadvantages of birthweight-specific comparisons between neonatal units. The aims of this study were to assess the ability of CRIB score compared to birthweight and gestational age to predict hospital mortality in very low birthweight infants and to use CRIB score in auditing one unit's performance during a prolonged time period. The charts of 335 infants with birthweight < or = 1500 g born between 1980 and 1995 were reviewed retrospectively. CRIB predicted hospital mortality significantly better than birthweight and gestation and performed equally well, whether the infants were treated with synthetic surfactant or not. When adjusting for CRIB score there was a significant improvement in the unit's performance, probably owing to the introduction of surfactant. As small samples tend to be associated with wide confidence intervals, use of CRIB is recommended in comparing risk adjusted mortality in a single unit over several years, as in this study, or between large groups of neonatal units over shorter periods.