Interstage Management Nancy S Ghanayem, Nancy A Rudd, David W Brown, James S Tweddell Abstract Historically, interstage management of infants following Norwood or stage I palliation, and prior to stage II palliation, had been limited by wide variation in care and inadequate monitoring Physiologic changes resulting from residual or recurrent lesions or the development of intercurrent illness have been linked to interstage mortality rates of 10% to 20% Interstage home monitoring programs that engage families and providers for home monitoring of physiologic variances has led to improved interstage survival Discharge planning, caregiver education, and care coordination are key elements for successful transition to home Key components of home surveillance monitoring programs include tracking of oxygen saturation, infant feeding, and weight at home; a dedicated interstage care team; weekly contact with family; and specialized interstage clinics The additional value of interstage home monitoring programs has been the growing collaboration between health care providers and parents with a goal of not only improving survival but also optimizing growth and developmental outcomes for infants born with hypoplastic left heart and other forms of functionally univentricular congenital heart disease Keywords hypoplastic left heart syndrome; stage 1 Norwood palliation; interstage; home monitoring Introduction Several fundamentals of perioperative care for shunt-dependent dual-distribution circulation (see Chapter 70) extend to transitional care from the intensive care unit and throughout the interstage period in an effort to preserve organ function and promote somatic growth Conventional outpatient surveillance limited to vital signs and routine growth assessment has historically been associated with high interstage mortality rates after discharge from Norwood or stage I palliation and prior to stage II palliation.1,2 (For the purposes of this chapter, stage II palliation refers to the general concepts of a superior cavopulmonary connection, the specific type of which depends on the individual patient's anatomy and surgical preference.) Interstage programs that leverage engagement of families and providers for vigilant monitoring of physiologic variances has led to improved interstage survival.1,3–7 The initial report of interstage monitoring noted a reduction of interstage death with a sustained single-center interstage survival rate for infants discharged to home of 98% over a 10-year period.3,8 Over the past 15 years, the unanticipated benefits of interstage monitoring have included improvement in somatic growth9,10 and less arbitrary timing of stage II palliation.11,12 Additional value has been the growing collaboration between numerous health care disciplines and parent advocates13–16 for the sole purpose of not only improving survival but also quality of life for infants born with hypoplastic left heart syndrome and related variants