Perioperative infections in congenital heart disease

Abstract

Background: Perioperative infections have significant consequences for children with congenital heart disease (CHD), which can manifest as acute or chronic infection followed by poor growth and progressive cardiac failure. The consequences include delayed or higher-risk surgery, and increased postoperative morbidity and mortality. Methods: A systematic search for studies evaluating the burden and interventions to reduce perioperative infections in children with CHD was undertaken using PubMed. Results: Limited studies conducted in low-to middle-income countries demonstrated the large burden of perioperative infections among children with CHD. Most studies focussed on infections after surgery. Few studies evaluated strategies to prevent preoperative infection or the impact of infection on decision-making around the timing of surgery. Children with CHD have multiple risk factors for infections including delayed presentation, inadequate treatment of cardiac failure, and poor nutrition. Conclusions: The burden of perioperative infections is high among children with CHD, and studies evaluating the effectiveness of interventions to reduce these infections are lacking. As good nutrition, early corrective surgery, and measures to reduce nosocomial infection are likely to play a role, practical steps can be taken to make surgery safer.

Outcome of pediatric cardiac surgery and predictors of major complication in a developing country

“…Practical steps can be taken to make surgery safer since good nutrition, early corrective surgery, and measures to reduce nosocomial infection are likely to play a role. [21]…”

The Need for Specialized Pediatric Cardiac Critical Care Training Program in Limited Resource Settings

“…Among those who present with the late diagnosis of CHD, fewer options of beneficial surgical procedures are available due to complications at the time of diagnosis. Some of the most common complications among those who present with delayed diagnosis of CHD include congestive heart failure, severe pulmonary hypertension, severe malnutrition, chronic infection, severe polycythemia, chronic hypoxia, and stroke ( 13 , 14 ).…”

“…Management of these sequelae due to the late presentation are challenging and requires a comprehensive and multidisciplinary approach focusing on the complexity of CHD, therapeutic options, surgical complexity and postoperative management. Most patients require nutritional rehabilitation, control of heart failure management of pulmonary hypertension, prevention of hypoxic spell, treatment of infective endocarditis, and correction of anemia ( 13 , 14 ). There is a need for multidisciplinary approach to the patient, which requires significant training of the individual members of the team.…”

Pediatric Cardiac Intensive Care Society Statement: caring for children with critical cardiac disease across the globe

“…Within this PCICS Global Statement, state-of-the-art material on all of these topics is presented directly by experts in the field based in -amongst other places -Asia, Africa, and South America. [2][3][4] Third, all paediatric cardiac programmes have a common goal of treating patients to the highest standard and delivering optimal outcomes while working with available resources, and this depends on the availability of a suitably skilled workforce. PCICS as an organisation holds a fierce commitment to education, training, and guidance as to best practice.…”

“…Doctors and nurses based in low- and middle-income settings encounter a greater range and severity of clinical scenarios within these categories, and hence they have evolved skills and expertise in dealing with these in the best possible way to ensure optimal outcomes among their patients. Within this PCICS Global Statement, state-of-the-art material on all of these topics is presented directly by experts in the field based in –amongst other places – Asia, Africa, and South America 2 4 …”