Effect of acid–base balance on postoperative course in children with hypoplastic left heart syndrome after the modified Norwood procedure

Abstract

Hypoplastic left heart syndrome (HLHS) is a congenital heart defect that requires 3-stage cardiac surgical treatment and multidirectional specialist care. The condition of newborns in the first postoperative days following the modified Norwood procedure is characterized by considerable hemodynamic instability that may result in a sudden cardiac arrest. It is believed that the most important cause of hemodynamic instability is the fluctuations in redistribution between pulmonary and systemic blood flow.The paper analyzes the postoperative course in 40 neonates with HLHS following the modified Norwood procedure performed under deep hypothermic cardiopulmonary bypass hospitalized in Cardiac Surgical Intensive Care Unit (CSICU) in the years 2014–2015. For all hospitalized children, the arterial blood acid–base balance (ABB) parameters (pH, pO2, pCO2, HCO3, base excess (BE), and lactic acid) were measured 2 times a day during the first 5 postoperative days. The main goal of the studies is to analysis of ABB parameters and their influence on the clinical state of newborns with HLHS. Several descriptors were concerned to describe the neonates clinical state: the date of the surgery (the day of life when the child was operated on), the duration (number of days) of mechanical ventilation employment, the time of hospitalization in intensive care unit, and the total duration of treatment in CSICU.The statistical analysis of the particular ABB parameters revealed a significant dependence (P < .001) between the values of pH, pO2, pCO2, HCO3, BE, lactic acid, and all concerned descriptors of the newborn clinical state.The article shows that monitoring the ABB parameters, proper interpretation of the results, and appropriate modification of pharmacotherapy and respiratory treatment are crucial for therapeutic results and survival rates in neonates with HLHS after the modified Norwood procedure.

Cardiac Arrest in Children Following Cardiac Surgery: A Scoping Review of Contributing Factors

“…[28][29][30][31][32][33] Laboratory markers of poor outcomes other than arrest included serum lactate, acid-base balance, central venous oxygen saturation, arterial pH, base excess, and oxygen extraction ratio. [34][35][36][37][38] Two studies identified novel laboratory markers associated with adverse outcomes related to low cardiac output following surgery: alkaline phosphatase and neutrophil gelatinase-associated lipocalin. Further research examining the utility of these novel biomarkers as predictive indices for cardiac arrest, considering its relationship to low cardiac output syndrome, should be explored.…”

The beneficial role of simple inflammatory blood indices in pediatric cardiology

“…9 The assessment of cardiovascular disease prognosis and procedural outcomes highlighted several parameters and biomarkers. [10][11][12][13][14][15] Many of them, including interleukins, microribonucleic acids (microRNAs), tumor necrosis factor alpha (TNF-α), and platelet-leukocyte aggregates, 16,17 have high prognostic value. However, using such markers in clinical practice is not possible, as a profound analysis of inflammatory phenomena is challenging and not costeffective.…”