Risk factors for nosocomial infections after cardiac surgery in newborns with congenital heart disease

García, Heladia; Cervantes-Luna, Beatriz; González-Cabello, Héctor Jaime; Miranda-Novales, Guadalupe

doi:10.1016/j.pedneo.2017.11.014

Cited by 21 publications

(22 citation statements)

References 30 publications

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“…In addition, by increasing enteral feeds, the risks associated with prolonged TPN are avoided. All this should be of benefit to these infants who are at risk of developing postoperative severe bacterial infections 24. As described in a review by Niño et al , multiple randomised clinical trials have now validated the observation that breast milk reduces the incidence of NEC 25.…”

Section: Discussionmentioning

confidence: 94%

Low risk of necrotising enterocolitis in enterally fed neonates with critical heart disease: an observational study

Nordenström

Lannering

Mellander

et al. 2020

Arch Dis Child Fetal Neonatal Ed

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ObjectiveWe aimed to investigate the frequency of necrotising enterocolitis (NEC) in infants with critical congenital heart disease (CCHD) hypothesising that preoperative enteral feeding does not increase the risk of NEC.BackgroundWhen NEC affects term infants, underlying risk factors such as asphyxia, sepsis or CCHD are often found. Due to fear of NEC development in infants with CCHD great caution is practised in many countries to defer preoperative enteral feeding, but in Sweden this is routinely provided.Design, setting and patientsAn observational study of all infants born with CCHD who were admitted to Queen Silvia Children’s Hospital in Gothenburg between 2010 and 2017. The International Classification of Diseases 10th Revision diagnosis code of NEC was used to identify NEC cases in this group. Infants described as ‘fully fed’ or who were fed at least 45 mL/kg/day before cardiac surgery were identified.Main outcome measuresNEC in infants with CCHD in relation to preoperative enteral feeding.ResultsThere were 458 infants with CCHD admitted during the study period. 408/458 were born at term and 361/458 required prostaglandin E1 before surgery. In total, 444/458 infants (97%) were fully fed or fed at least 45 mL/kg daily before cardiac surgery. Four of 458 infants developed NEC (0.9%). All four had other risk factors for NEC.ConclusionsThis study showed a low risk of NEC in term infants fed enterally before cardiac surgery. We speculate that preoperative enteral feeding of neonates with CCHD does not increase the risk of NEC development.

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Section: Discussionmentioning

confidence: 94%

Low risk of necrotising enterocolitis in enterally fed neonates with critical heart disease: an observational study

Nordenström

Lannering

Mellander

et al. 2020

Arch Dis Child Fetal Neonatal Ed

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“…Patients experiencing severe bleeding while on ECMO are treated with large doses of RBCs, FFP, and PLTs. Massive transfusions are a known risk factor for infections in cardiac surgery both in pediatric 19 and adult 20 patients. In addition, they have an increased manipulation of the infusion lines and more often require surgical re-explorations, which are again risk factors for infections.…”

Section: Discussionmentioning

confidence: 99%

Bloodstream infections during post-cardiotomy extracorporeal membrane oxygenation: Incidence, risk factors, and outcomes

et al. 2018

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Introduction: Veno-arterial extracorporeal membrane oxygenation after heart surgery is a relatively common procedure. It is easily applicable but associated with a number of complications, including bloodstream infections. The aim of this study is to determine the current rate and the risk factors related to bloodstream infections acquired during post-cardiotomy veno-arterial extracorporeal membrane oxygenation. Methods: Single-center retrospective study. From the overall population receiving any kind of extracorporeal membrane oxygenation from March 2013 through December 2017, the post-cardiotomy patient population was extracted, with a final sample of 92 veno-arterial extracorporeal membrane oxygenations. The risk of developing bloodstream infections as a function of extracorporeal membrane oxygenation exposure was analyzed with appropriate statistical analyses, including a Kaplan–Meier analysis. Results: Overall, 14 (15.2%) patients developed a bloodstream infection during extracorporeal membrane oxygenation or within the first 48 h after extracorporeal membrane oxygenation removal. The total extracorporeal membrane oxygenation duration in the population was 567 days, and the incidence of bloodstream infections was 24.7 bloodstream infections/1000 extracorporeal membrane oxygenation days. There was a progressive increase in the cumulative hazard ratio during the first 7 days, reaching a value of 20% on day 7; from day 7 and day 15, the hazard ratio remained stable, with a second increase after day 15. The independent risk factors associated with bloodstream infections were adult age, pre-implantation serum total bilirubin level, and the amount of chest drain blood loss. Discussion: Infections acquired during veno-arterial extracorporeal membrane oxygenation are common. Identify the risk factors that may improve strategies for treatment and prevention.

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“…[ 10 ] Another retrospective study of 634 CHD patients from the USA reported that 38 patients were diagnosed with HAIs 90 days after surgery, including 19 blood-borne infections (3.0%), 9 operative site infections (1.4%), 6 infective endocarditis (0.95%), and 4 ventilator-related pulmonary infections (0.6%); the total infection rate was 5.99%. [ 11 ] Many studies have confirmed [ 12 – 15 ] that young age, underweight, long operation time, long clamping time, long mechanical ventilation time, and long ICU stay are risk factors for HAIs, but the results were inconsistent to varying degrees in quantitative risk indicator studies. A study in neonates from the USA reported that the risk factors for HAIs also included central venous catheter indwelling time >14 days and >5 postoperative blood transfusions.…”

Section: Discussionmentioning

confidence: 99%

The risk factors analysis and establishment of an early warning model for healthcare-associated infections after pediatric cardiac surgery

Meng

et al. 2020

Medicine

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The aim of this study was to identify the main risk factors for health-care-associated infections (HAIs) following cardiac surgery and to establish an effective early warning model for HAIs to enable intervention in an earlier stage. In total, 2227 patients, including 222 patients with postoperative diagnosis of HAIs and 2005 patients with no-HAIs, were continuously enrolled in Beijing Anzhen Hospital, Beijing, China. Propensity score matching was used and 222 matched pairs were created. The risk factors were analyzed with the methods of univariate and multivariate logistic regression. The receiver operating characteristic (ROC) curve was used to test the accuracy of the HAIs early warning model. After propensity score matching, operation time, clamping time, intubation time, urinary catheter time, central venous catheter time, ≥3 blood transfusions, re-endotracheal intubation, length of hospital stay, and length of intensive care unit stay, still showed significant differences between the 2 groups. After logistic model analysis, the independent risk factors for HAIs were medium to high complexity, intubation time, urinary catheter time, and central venous catheter time. The ROC showed the area under curve was 0.985 (confidence interval: 0.975–0.996). When the probability was 0.529, the model had the highest prediction rate, the corresponding sensitivity was 0.946, and the specificity was 0.968. According to the results, the early warning model containing medium to high complexity, intubation time, urinary catheter time, and central venous catheter time enables more accurate predictions and can be used to guide early intervention after pediatric cardiac surgery.

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Risk factors for nosocomial infections after cardiac surgery in newborns with congenital heart disease

Abstract: Newborns with non-cardiac congenital malformations and with >7 days of mechanical ventilation were at higher risk for a postoperative NI. Efforts must focus on preventable infections, especially in bloodstream catheter-related infections, which account for 20.5% of all NIs.

Cited by 21 publications

References 30 publications

Low risk of necrotising enterocolitis in enterally fed neonates with critical heart disease: an observational study

Low risk of necrotising enterocolitis in enterally fed neonates with critical heart disease: an observational study

Bloodstream infections during post-cardiotomy extracorporeal membrane oxygenation: Incidence, risk factors, and outcomes

The risk factors analysis and establishment of an early warning model for healthcare-associated infections after pediatric cardiac surgery

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