Inpatient Clinical Pathway for the Evaluation/Treatment of a Newborn
with Norwood Physiology or Shunt Dependent Pulmonary Blood Flow
Pre-operative care
- Perioperative guidelines for neonates undergoing Norwood operation
- CICU Consult Attending
- Consult Social Work and Case Management to support insurance needs
- Evaluate/enroll in Single Ventricle Monitoring Program
Intraoperative care
- Intraoperative guidelines for neonates undergoing Norwood operation
- Hemodynamic monitoring
- Vascular access
- Anesthesia plan
- Airway management
- Cardiopulmonary bypass
- Medications
- Hemostasis
- OR team debrief, OR to CICU handoff
Post-operative Care
- Post-operative guidelines days 0-2 after
Norwood operation- Hemodynamic monitoring
- Respiratory support
- Fluid management
- Pain management — CICU Sedation Pathway
- Medications
- Nutrition — Nutrition for CHD Pathway
- Identify outpatient cardiologist prior to CICU transfer
De-intensification in 2-3 days
Not achieved
Achieved
- Focused echo to assess for:
- Residual defects
- Ventricular dysfunction
- AVVR
- Effusions
Continued recovery and discharge planning
- OT/PT Consults
- Social Work, Case Management Consults
- Parent Discharge Checklist
- Feeding advancement:
- Detailed post-op echo within 7 days of operation:
- Perform routine echo surveillance while inpatient:
- Stage I: every 2 weeks, focused echo
- Hybrid: weekly
- Discharging CCU attending to discuss surgical planning with primary cardiologist and consider submission of paperwork for surgery
- Infant Single Ventricle Monitoring Program
(ISVMP) Consult - ISVMP Clinical Pathway for Providers
- NP/discharge evaluation, note in Epic
Discharge
- Review Parent Discharge Checklist
- ISVMP APN — Discharge Consult
- Contacts community providers
- Sends information, protocols, patient reports
- ISVMP Clinical Pathway for Providers
Evidence
- Home Surveillance Program Prevents Interstage Mortality after the Norwood Procedure
- Decreasing Interstage Mortality After the Norwood Procedure: A 30-Year Experience
- Standardization of the Perioperative Management for Neonates Undergoing the Norwood Operation for Hypoplastic Left Heart Syndrome and Related Heart Defects
- Evaluating the Utility of Routine Screening Catheterisation Before Interstage Discharge of Infants with Single-ventricle Physiology
CHOP Programs
Related Links