ObjectiveTo summarize the clinical experience and risk factors for acute kidney injury (AKI) in neonates undergoing congenital cardiac surgery and demonstrate whether neonatal AKI after cardiac surgery was independently related to perioperative short-term outcomes. MethodsMedical records of neonates undergoing congenital heart surgery from January 2014 to September 2021 were retrospectively reviewed. The patients were divided into an AKI group and a non-AKI group according to whether the AKI occured after the surgery. Multivariate logistic analysis was performed to analyze the risk factors for postoperative AKI and the relationship between postoperative AKI and postoperative short-term outcomes. ResultsA total of 609 patients were included. There were 395 males and 214 females with an age at surgery of 1.0-28.0 d and weight of 1.9-4.8 kg. After cardiac surgery, 139 neonates developed AKI. Multivariate logistic analysis showed that less intraoperative urine output [OR=0.96, 95%CI (0.94, 0.99), P=0.005], more intraoperative infusion of red blood cells [OR=1.49, 95%CI (1.16, 1.91), P=0.002], longer intraoperative deep hypothermic circulatory arrest time [OR=1.02, 95%CI (1.00, 1.04), P=0.020], higher vasoactive-inotropic score [OR=1.03, 95%CI (1.01, 1.04), P<0.001] and elevated lactate (increasing by 5 mmol/L) [OR=2.90, 95%CI (1.76, 4.76), P<0.001] when transferred to ICU were independent risk factors for AKI. AKI was an independent risk factor for increased in-hospital mortality [OR=12.61, 95%CI (3.00, 37.48), P<0.001]. ConclusionLess intraoperative urine output, more intraoperative infusion of red blood cells, longer intraoperative deep hypothermic circulatory arrest time, higher vasoactive-inotropic score and elevated lactate when transferred to ICU are independent risk factors for AKI. Furthermore, AKI is an independent risk factor for perioperative death after cardiac surgery.
ObjectiveTo analyze the early outcomes of 203 neonates with low birth weight (<2 500 g) undergoing cardiac surgery, and to analyze the causes of death during hospitalization.MethodsFrom June 2003 to June 2017, medical records of 203 neonates with low birth weight undergoing congenital heart surgery in Guangdong General Hospital were reviewed retrospectively. There were 124 males and 79 females, including 151 premature infants. The average birth weight was 1 719±515 g, the average age at operation was 32.7±20.2 d and the average weight at operation was 1 994±486 g. The causes of death during hospitalization (including neonates given up on treatments) were analyzed.ResultsTotally 103 patients had pneumonia, 98 patients needed mechanical ventilation to support breathing and 26 patients needed emergency operation before operation. All patients undergoing congenital heart surgery were treated with general anesthesia with tracheal intubation, including 107 patients under non cardiopulmonary bypass (CPB) and 96 patients under CPB with a mean CPB time of 96.5±71.7 min and a mean aorta cross-clamp time of 51.8±45.5 min. The average postoperative mechanical ventilation time was 9.1±21.5 d and the average postoperative length of stay was 26.7±19.3 d. The major postoperative complications included pneumonia, anemia, atelectasis, septicemia, intrapleural hemorrhage, diaphragm paralysis and cardiac dysfunction. Twenty-nine patients died during hospitalization and the overall mortality rate was 14.3%. Four patients died in the operation room, 14 patients died 72 hours after operation and 2 patients were given up. The main causes of hospitalized death were low cardiac output syndrome, severe infection, disseminated intravascular coagulation disorder, acute renal failure and pulmonary hypertension crisis.ConclusionOverall, early cardiac surgery for low birth weight neonates is safe and effective. The difficulty of the cardiac surgery is the key to the prognosis. Strengthening perioperative management can improve the quality of operation and reduce the risk of mortality and morbidity during hospitalization.