Five-year Analysis of Operative Mortality and Neonatal Outcomes in Congenital Heart Disease

Padley, James R.; Cole, Alexander J.; Pye, Victoria; Chard, Richard B.; Nicholson, Ian; Jacobe, Stephen; Baines, David; Badawi, Nadia; Walker, Karen; Scarfe, Gabbie; Leclair, Karen; Sholler, Gary F.; Winlaw, David S.

doi:10.1016/j.hlc.2011.03.009

Cited by 31 publications

(31 citation statements)

References 23 publications

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“…Surgical case series have highlighted important associations between increased postoperative mortality risk and factors such as low birth weight [33], [34], preterm birth [35], sudden clinical deterioration in the neonatal period [36], [37], and procedure-associated complications, including sepsis and renal failure [38]. Several studies have demonstrated the detrimental impact of longer intra-procedure duration of cardiopulmonary bypass and cardiac arrest [39]–[42], also observed in our cohort, although most previous authors estimated the effect at a single procedure only rather than repeated exposure over multiple procedures.…”

Section: Discussionmentioning

confidence: 99%

Modelling Survival and Mortality Risk to 15 Years of Age for a National Cohort of Children with Serious Congenital Heart Defects Diagnosed in Infancy

et al. 2014

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BackgroundCongenital heart defects (CHDs) are a significant cause of death in infancy. Although contemporary management ensures that 80% of affected children reach adulthood, post-infant mortality and factors associated with death during childhood are not well-characterised. Using data from a UK-wide multicentre birth cohort of children with serious CHDs, we observed survival and investigated independent predictors of mortality up to age 15 years.MethodsData were extracted retrospectively from hospital records and death certificates of 3,897 children (57% boys) in a prospectively identified cohort, born 1992–1995 with CHDs requiring intervention or resulting in death before age one year. A discrete-time survival model accounted for time-varying predictors; hazards ratios were estimated for mortality. Incomplete data were addressed through multilevel multiple imputation.FindingsBy age 15 years, 932 children had died; 144 died without any procedure. Survival to one year was 79.8% (95% confidence intervals [CI] 78.5, 81.1%) and to 15 years was 71.7% (63.9, 73.4%), with variation by cardiac diagnosis. Importantly, 20% of cohort deaths occurred after age one year. Models using imputed data (including all children from birth) demonstrated higher mortality risk as independently associated with cardiac diagnosis, female sex, preterm birth, having additional cardiac defects or non-cardiac malformations. In models excluding children who had no procedure, additional predictors of higher mortality were younger age at first procedure, lower weight or height, longer cardiopulmonary bypass or circulatory arrest duration, and peri-procedural complications; non-cardiac malformations were no longer significant.InterpretationWe confirm the high mortality risk associated with CHDs in the first year of life and demonstrate an important persisting risk of death throughout childhood. Late mortality may be underestimated by procedure-based audit focusing on shorter-term surgical outcomes. National monitoring systems should emphasise the importance of routinely capturing longer-term survival and exploring the mechanisms of mortality risk in children with serious CHDs.

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Section: Discussionmentioning

confidence: 99%

Modelling Survival and Mortality Risk to 15 Years of Age for a National Cohort of Children with Serious Congenital Heart Defects Diagnosed in Infancy

et al. 2014

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“…2 In addition, the postoperative recovery is often a nonlinear process, requiring multidisciplinary care to manage comorbid conditions and complications, including prolonged intubation, chylothorax, bleeding, infection, cardiac arrest, seizures, failure to thrive, and feeding difficulties. 8,9 Because infants often experience some of these complications, parental stress is further exacerbated. Moreover, parents of children with CHD report higher amounts of stress than parents of healthy children or parents of children with other diseases.…”

mentioning

confidence: 99%

Maternal Stress and Anxiety in the Pediatric Cardiac Intensive Care Unit

Lisanti

Allen

Kelly

et al. 2017

American Journal of Critical Care

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Background Mothers whose infants are born with complex congenital heart disease (CCHD) experience stress during their infant’s hospitalization in a pediatric cardiac intensive care unit (PCICU). Objectives This study addressed 2 research questions: (1) What are the parental stressors for mothers whose infants with CCHD are in the PCICU? And (2) What are the relationships of trait anxiety and 3 parental stressors to the parental stress response of state anxiety in mothers whose infants with CCHD are in the PCICU? Methods This descriptive correlational study included 62 biological mothers of infants admitted to a PCICU within 1 month of birth who had undergone cardiac surgery for CCHD. Maternal and infant demographics and responses to the Parental Stressor Scale: Infant Hospitalization and the State-Trait Anxiety Inventory were collected at 3 major PCICUs across the United States. Results Mothers’ scores revealed that infant appearance and behavior was the greatest stressor, followed by parental role alteration, then sights and sounds. The combination of trait anxiety and parental role alteration explained 26% of the variance in maternal state anxiety. Mothers with other children at home had significantly higher state anxiety than did mothers with only the hospitalized infant. Conclusions Results from this study revealed factors that contribute to the stress of mothers whose infants are born with CCHD and are hospitalized in a PCICU. Nurses are in a critical position to provide education and influence care to reduce maternal stressors in the PCICU, enhance mothers’ parental role, and mitigate maternal state anxiety.

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“…The literature suggests that patient outcomes can differ according to the size and structure of an individual unit, with the trend internationally towards larger units that perform at least major 300 cases per year 1,2 . Public reporting of mortality data allows comparisons to other facilities and is starting to drive health policy in several countries 3 including the forced concentration of expertise into fewer centres. Benchmarking of morbidity and quality data are not systematically undertaken, which is surprising given the significant resources expended and the impact of paediatric outcomes on the quality of later adult life and the overall financial impact on society.…”

Section: Structures and Outcomes In Australasian Unitsmentioning

confidence: 99%

Where to now for paediatric cardiac surgery?

Winlaw

d’Udekem

Barach

2011

ANZ Journal of Surgery

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ns_5888 659..660With the rise of adult cardiac surgery, those aspiring to be surgeons are often surprised that that the specialty was conceived by those dreaming of closing atrial and ventricular septal defects. From cross circulation to the modern oxygenator, technological evolution was coupled with a surgical revolution of over 50 highly productive years. More recently, the quality of care for the majority of paediatric cardiac conditions has become more consistent with an overall mortality of 2-4% across the developed world. This marks what can be regarded as a phase of refinement and maturation. Efforts to improve cardiac surgery safety have been ongoing, yet the literature provides little guidance regarding best practices for identifying errors, improving safety and sustaining high reliability. A reflection on our current structures and models of engagement suggest that changes will be required to support the next phase of growth in Australasia. EDITORIAL ANZJSurg.com

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Five-year Analysis of Operative Mortality and Neonatal Outcomes in Congenital Heart Disease

Cited by 31 publications

References 23 publications

Modelling Survival and Mortality Risk to 15 Years of Age for a National Cohort of Children with Serious Congenital Heart Defects Diagnosed in Infancy

Modelling Survival and Mortality Risk to 15 Years of Age for a National Cohort of Children with Serious Congenital Heart Defects Diagnosed in Infancy

Maternal Stress and Anxiety in the Pediatric Cardiac Intensive Care Unit

Where to now for paediatric cardiac surgery?

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