Hypoplastic left heart syndrome: attitudes among pediatric residents and nurses towards fetal and neonatal management

Authors

  • P. Renella,

    Corresponding author
    1. Division of Pediatric Cardiology, Mattel Children's Hospital at the University of California Los Angeles (UCLA) Medical Center, 10833 Le Conte Avenue, MDCC, B2-427 Los Angeles, CA 90095, USA
    • Division of Pediatric Cardiology, Mattel Children's Hospital at the University of California at Los Angeles (UCLA) Medical Center, 10833 Le Conte Avenue, MDCC, B2-427 Los Angeles, CA 90095, USA.
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  • R.-K. R. Chang,

    1. Division of Pediatric Cardiology, Harbor-UCLA Medical Center, 1000 W. Carson Street, Torrance, CA 90502, USA
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  • D. A. Ferry,

    1. Division of Pediatric Cardiology, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
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  • R. D. Bart,

    1. Division of Critical Care Medicine, Childrens Hospital Los Angeles, 4650 Sunset Blvd, Mailstop #12, Los Angeles, CA 90027, USA
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  • M. S. Sklansky

    1. Division of Cardiology, Childrens Hospital Los Angeles, 4650 Sunset Blvd, Mailstop #34, Los Angeles, CA 90027, USA
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Abstract

Objective

To determine the attitudes of pediatric residents and nurses towards fetal/neonatal management of hypoplastic left heart syndrome (HLHS), and their basis.

Methods

Pediatric residents and nurses from three cardiac centers completed a survey with hypothetical scenarios in which their own fetuses or newborns had HLHS. While Institution A performs many HLHS surgeries, Institution C performs very few.

Results

A total of 43% of residents and 50% of nurses would terminate an affected pregnancy. More experience (4 to 7 years, p = 0.04; >7 years, p = 0.05) and employment at institution C (p = 0.04) predicted termination. Expected better quality of life (QOL) (p = 0.02) and five-year survival >50% (p = 0.06) predicted not terminating. Postnatally, 48% of residents and 68% of nurses would choose, or seriously consider, comfort care. Marriage (p = 0.04) and more experience (4 to 7 years, p = 0.04; >7 years, p = 0.02) predicted choosing comfort care. Asian/Pacific Islander descent (p = 0.01) and expected 5-year survival >50% (p = 0.02) predicted choosing surgery.

Conclusions

Approximately one-half of the pediatric residents and nurses surveyed would choose termination of pregnancy or seriously consider declining neonatal surgery, if their own fetus or infant had HLHS. These attitudes reflect perceptions of long-term QOL and survival. These attitudes may be of interest to caregivers who care for HLHS patients. Copyright © 2007 John Wiley & Sons, Ltd.

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