0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Commentary |

The Paradigm Shift Toward Surgical Intervention for Neonates With Hypoplastic Left Heart Syndrome

Gil Wernovsky, MD
Arch Pediatr Adolesc Med. 2008;162(9):849-854. doi:10.1001/archpedi.162.9.849.
Text Size: A A A
Published online

Extract

Should nonintervention (or what some physicians call comfort care) be offered as an option to parents of neonates with hypoplastic left heart syndrome (HLHS)? While this may have been a reasonable choice 2 decades ago, I will argue that—for 2 primary reasons having to do with improvements in outcomes over time and by comparing HLHS with other life-threatening pediatric conditions—nonintervention should no longer be offered.

Let me state up front that I have come to these opinions through working at 2 large tertiary care, academic medical centers during the past 20 years. Both of these centers have been and still very much are strong advocates for intervention in children with high-risk, complex congenital heart disease (CHD). These centers have cared for many children whose families specifically traveled there for these high-risk interventions. My opinions undoubtedly reflect that bias and experience. My practice and research have focused on cardiac intensive care and outpatient pediatric cardiology, including direct care and treatment of postoperative patients through childhood. Admittedly, my perspective reflects a different experience and outlook than those that many pediatric cardiologists, neonatologists, and pediatric intensivists have had in the same time frame. However, participating in and observing first hand the progress that has been made in HLHS in the past 2 decades has been particularly rewarding and forms the basis of my opinions.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 19

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();