Cardiac intensive care for the neonate and child after cardiac surgery

DeSena, Holly C.; Nelson, David P.; Cooper, David S.

doi:10.1097/hco.0000000000000127

Cited by 18 publications

(12 citation statements)

References 64 publications

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“…11 Adjusting serum creatinine (SCr) values for fluid balance is essential in predicting the subtle early signs of AKI. 12 Adjusted SCr Z measured SCr Â (1 þ [cumulative net fluid balance (L)/total body water (kg)])…”

Section: Classification and Staging Of Acute Kidney Injurymentioning

confidence: 99%

“…Higher risk adjustment for congenital heart surgery (RACHS-1) scores (3 and above) 12,13 Presence of cyanotic lesions 10 Uncorrected or residual cardiac defects 4 Cardiopulmonary bypass (nonpulsatile flow; inflammatory cascade) 12 Longer cardiopulmonary bypass time 12 Hypothermic circulatory arrest 34 Requirement of inotropic support 10,12 Low cardiac output syndrome 12 Prolonged ventilator requirement 14 Need for extracorporeal membrane oxygenation (ECMO) 35 Early fluid overload 14…”

Section: Hemodynamicmentioning

confidence: 99%

“…Patients undergoing peritoneal dialysis had decreased levels of IL-6 and IL-8, suggesting removal of inflammatory cytokines by peritoneal dialysis. 12 Intermittent hemodialysis is suitable for children with intoxications. CRRT serves as controlled fluid removal in critically ill children.…”

Section: Inflammatorymentioning

confidence: 99%

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Acute kidney injury after pediatric cardiac surgery

Yuan

2019

Pediatrics & Neonatology

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Acute kidney injury (AKI) is a common complication of pediatric cardiac surgery and is associated with increased morbidity and mortality. Literature of AKI after pediatric cardiac surgery is comprehensively reviewed in terms of incidence, risk factors, biomarkers, treatment and prognosis. The novel RIFLE (pediatric RIFLE for pediatrics), Acute Kidney Injury Network (AKIN) and Kidney Disease Improving Global Outcomes (KDIGO) criteria have brought about unified diagnostic standards and comparable results for AKI after cardiac surgery. Numerous risk factors, either renal or extrarenal, can be responsible for the development of AKI after cardiac surgery, with low cardiac output syndrome being the most pronounced predictor. Early fluid overload is also crucial for the occurrence of AKI and prognosis in pediatric patients. Three sensitive biomarkers, neutrophil gelatinase-associated lipocalin, cystatin C (CysC) and liver fatty acid-binding protein, are regarded as the earliest (increase at 2-4 h), and another two, kidney injury molecule-1 and interleukin-18 represent the intermediate respondents (increase at 6-12 h after surgery). To ameliorate the cardiopulmonary bypass techniques, improve renal perfusion and eradicate the causative risk factors are imperative for the prevention of AKI in pediatric patients. The early and intermediate biomarkers are helpful for an early judgment of occurrence of postoperative AKI. Improved survival has been achieved by prevention, renal support and modifications of hemofiltration techniques. Further development is anticipated in small children.

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Section: Classification and Staging Of Acute Kidney Injurymentioning

confidence: 99%

Section: Hemodynamicmentioning

confidence: 99%

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Acute kidney injury after pediatric cardiac surgery

Yuan

2019

Pediatrics & Neonatology

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“…Extended hospital stay after a cardiovascular surgery has been associated with increased risk of infection, poor neurodevelopmental outcomes in neonates and increased hospital costs [32]; thus, it is highly desirable to reduce the length of the NICU stay. Shorter NICU stay in our DHA group was consistent with shorter stay in ICUs for the surgical adults who received n-3 LC-PUFAs reported in meta-analyses [9,31,33].…”

Section: Discussionmentioning

confidence: 99%

Beneficial Effects of Enteral Docosahexaenoic Acid on the Markers of Inflammation and Clinical Outcomes of Neonates Undergoing Cardiovascular Surgery: An Intervention Study

Bernabe‐García¹,

López-Alarcón²,

Villegas-Silva

et al. 2016

Ann Nutr Metab

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Background: Neonates undergoing surgery are at risk for uncontrolled inflammatory response and adverse clinical outcomes. Docosahexaenoic acid (DHA) ameliorates inflammation, improving clinical outcomes. However, its effect has not been evaluated in neonates undergoing surgery. We evaluated the effect of DHA on markers of inflammation and clinical outcomes in neonates undergoing surgery. Methods: A double-blind clinical trial evaluated the effect of enteral DHA (DHA group) versus sunflower oil (SO group) perioperatively administered in neonates scheduled for cardiovascular surgery. Inflammation was evaluated by percentage of cells⁺ for cytokines and CD69 in mononuclear cells at baseline, 24 h and 7 days post surgery. Clinical outcomes measured were sepsis, organ dysfunctions (ODs), length of stay in intensive care and bleeding. Repeated measures analysis of variance and logistic regression were applied. Results: Sixteen neonates received DHA and 18 received SO. Cells⁺ from neonates in the DHA group showed an early increase in receptor antagonist of interleukin (IL)-1⁺ (IL-1ra⁺) and IL-10⁺ and a late decrease in IL-6⁺. IL-1β⁺ and IL-10⁺ changes were different between groups. After adjusting for confounders, less cells from DHA group were IL-1β⁺, IL-6⁺, IL-1ra⁺ and IL-10⁺. DHA group presented less sepsis, ODs and shorter stay, but no difference in CD69⁺CD4⁺ cells or bleeding between groups. Conclusions: Administration of enteral DHA ameliorates markers of inflammation and improves clinical outcomes in surgical neonates.

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“…43 Enteral feedings should be initiated early when the patient shows indications of adequate systemic output (low serum level of lactate, sufficient urine output, and good peripheral perfusion), with a goal of 120 to 150 kcal/kg per day. 43,44 Optimal weight gain is 20 to 30 g/d. 43 Nursing assessment includes monitoring feeding tolerance, nutritional intake, and daily calorie counts.…”

Section: Nutritionmentioning

confidence: 99%

Norwood Procedure for Palliation of Hypoplastic Left Heart Syndrome: Right Ventricle to Pulmonary Artery Conduit vs Modified Blalock-Taussig Shunt

Beke

2016

Critical Care Nurse

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Patients with hypoplastic left heart syndrome undergo a series of operations to separate the pulmonary and systemic circulations. The first of at least 3 operations occurs in the newborn period, with a stage I palliation. The goal of stage I palliation is to provide pulmonary blood flow and create an unobstructed systemic outflow tract. Advances in surgical techniques and intraoperative and postoperative care have helped decrease morbidity and mortality for patients with hypoplastic left heart syndrome who have the stage I Norwood operation, but the patients continue to be at increased risk for hemodynamic collapse and adverse outcomes. This article discusses risk factors, surgical approach, postoperative nursing and medical management strategies, differences between and outcomes for the Norwood operation with the right ventricle to pulmonary artery conduit and the Norwood operation with a modified Blalock-Taussig shunt.

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Cardiac intensive care for the neonate and child after cardiac surgery

Abstract: Postoperative care of the neonate and child following a cardiac surgery remains challenging with limited data to drive our practices. Patients remain at risk for significant morbidity, and future studies should focus on recognizing predictors of morbidity, prevention, and treatment.

Cited by 18 publications

References 64 publications

Acute kidney injury after pediatric cardiac surgery

Acute kidney injury after pediatric cardiac surgery

Beneficial Effects of Enteral Docosahexaenoic Acid on the Markers of Inflammation and Clinical Outcomes of Neonates Undergoing Cardiovascular Surgery: An Intervention Study

Norwood Procedure for Palliation of Hypoplastic Left Heart Syndrome: Right Ventricle to Pulmonary Artery Conduit vs Modified Blalock-Taussig Shunt

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