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Peritoneal catheters in neonates undergoing complex cardiac surgery: a multi-centre descriptive study.

Authors
  • Kwiatkowski, David M1
  • Alten, Jeffrey A2
  • Raymond, Tia T3
  • Selewski, David T4
  • Blinder, Joshua J1
  • Afonso, Natasha S5
  • Coghill, Matthew T6
  • Cooper, David S2
  • Koch, Joshua D7
  • Krawczeski, Catherine D8
  • Mah, Kenneth E1
  • Neumayr, Tara M9
  • Rahman, A K M Fazlur10
  • Reichle, Garret11
  • Tabbutt, Sarah12
  • Webb, Tennille N6
  • Borasino, Santiago6
  • 1 Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
  • 2 Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
  • 3 Department of Pediatrics, Medical City Children's Hospital, Dallas, TX, USA.
  • 4 Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
  • 5 Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
  • 6 Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA.
  • 7 Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ, USA.
  • 8 Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA.
  • 9 Department of Pediatrics, Washington University School of Medicine, St. Louis. MO, USA.
  • 10 Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA.
  • 11 Department of Pediatrics, University of Michigan School of Medicine, Ann Arbor, MI, USA.
  • 12 Department of Pediatrics, University of California - San Francisco School of Medicine, San Francisco, CA, USA.
Type
Published Article
Journal
Cardiology in the Young
Publisher
Cambridge University Press
Publication Date
Feb 01, 2024
Volume
34
Issue
2
Pages
272–281
Identifiers
DOI: 10.1017/S104795112300135X
PMID: 37337694
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The use of peritoneal catheters for prophylactic dialysis or drainage to prevent fluid overload after neonatal cardiac surgery is common in some centres; however, the multi-centre variability and details of peritoneal catheter use are not well described. Twenty-two-centre NEonatal and Pediatric Heart Renal Outcomes Network (NEPHRON) study to describe multi-centre peritoneal catheter use after STAT category 3-5 neonatal cardiac surgery using cardiopulmonary bypass. Patient characteristics and acute kidney injury/fluid outcomes for six post-operative days are described among three cohorts: peritoneal catheter with dialysis, peritoneal catheter with passive drainage, and no peritoneal catheter. Of 1490 neonates, 471 (32%) had an intraoperative peritoneal catheter placed; 177 (12%) received prophylactic dialysis and 294 (20%) received passive drainage. Sixteen (73%) centres used peritoneal catheter at some frequency, including six centres in >50% of neonates. Four centres utilised prophylactic peritoneal dialysis. Time to post-operative dialysis initiation was 3 hours [1, 5] with the duration of 56 hours [37, 90]; passive drainage cohort drained for 92 hours [64, 163]. Peritoneal catheter were more common among patients receiving pre-operative mechanical ventilation, single ventricle physiology, and higher complexity surgery. There was no association with adverse events. Serum creatinine and daily fluid balance were not clinically different on any post-operative day. Mortality was similar. In neonates undergoing complex cardiac surgery, peritoneal catheter use is not rare, with substantial variability among centres. Peritoneal catheters are used more commonly with higher surgical complexity. Adverse event rates, including mortality, are not different with peritoneal catheter use. Fluid overload and creatinine-based acute kidney injury rates are not different in peritoneal catheter cohorts.

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