Delgado-Corcoran Claudia, Blaschke Anne J, Ou Zhining, Presson Angela P, Burch Phillip T, Pribble Charles G, Menon Shaji C
Division of Pediatric Critical Care Medicine, Department of Pediatrics, School of Medicine, University of Utah, 295 Chipeta Way, PO BOX 581289, Salt Lake City, UT, 84108, USA.
Division of Pediatric Infectious Diseases, Department of Pediatrics, School of Medicine, University of Utah, 295 Chipeta Way, PO BOX 581289, Salt Lake City, UT, 84108, USA.
Pediatr Cardiol. 2019 Feb;40(2):339-348. doi: 10.1007/s00246-018-1994-5. Epub 2018 Oct 4.
Respiratory viral infections in infants undergoing congenital heart surgery lead to prolonged intubation time, hospital (HLOS) and cardiac intensive care unit length of stay (CICU LOS). The objective of this study was to evaluate the prevalence of respiratory viruses using molecular testing in otherwise healthy infants presenting for low complexity heart surgery, and to evaluate the impact of a positive viral screen and study questionnaire on post-surgical HLOS, CICU LOS, intubation time, respiratory complications, and oxygen therapy at home discharge. Sixty-nine infants (1 month to 1 year) undergoing cardiac surgery from November to May of the years 2012 to 2014 were prospectively enrolled, surveyed and tested. We compared the outcomes of positive molecular testing and positive study questionnaire to test negative subjects. We also evaluated the predictive value of study questionnaire in identification of viruses by molecular testing. Of the 69 enrolled infants, 58 had complete information available for analysis. 17 (30%) infants tested positive by molecular testing for respiratory pathogens. 38 (65%) had a "positive" questionnaire. Among the 20 viruses detected, Human Rhinovirus was the most common 12 (60%). Seven (12%) of the 58 patients developed respiratory symptoms following surgery prompting molecular testing. Four of these tested positive for a respiratory virus post-surgically. Neither positive molecular testing nor a positive questionnaire prior to surgery was associated with greater post-operative HLOS, CICU LOS, intubation time, respiratory complications, or use of oxygen at discharge compared to negative testing. The questionnaire poorly predicted positive molecular testing. Routine screening for respiratory viruses in asymptomatic infants may not be an effective strategy to predict infants at risk of post-operative complications.
接受先天性心脏手术的婴儿发生呼吸道病毒感染会导致插管时间延长、住院时间（HLOS）和心脏重症监护病房住院时间（CICU LOS）延长。本研究的目的是通过分子检测评估接受低复杂性心脏手术的健康婴儿中呼吸道病毒的流行情况，并评估病毒筛查阳性和研究问卷对术后HLOS、CICU LOS、插管时间、呼吸道并发症以及出院时家庭氧疗的影响。前瞻性纳入了2012年至2014年11月至5月期间接受心脏手术的69名婴儿（1个月至1岁），对其进行了调查和检测。我们将分子检测阳性和研究问卷阳性的结果与检测阴性的受试者进行了比较。我们还评估了研究问卷在通过分子检测识别病毒方面的预测价值。在69名纳入的婴儿中，58名有可供分析的完整信息。17名（30%）婴儿通过分子检测呼吸道病原体呈阳性。38名（65%）问卷为“阳性”。在检测到的20种病毒中，人鼻病毒最为常见，有12种（60%）。58名患者中有7名（12%）术后出现呼吸道症状，促使进行分子检测。其中4名术后呼吸道病毒检测呈阳性。与检测阴性相比，术前分子检测阳性或问卷阳性与术后更长的HLOS、CICU LOS、插管时间、呼吸道并发症或出院时吸氧均无关联。该问卷对分子检测阳性的预测能力较差。对无症状婴儿进行呼吸道病毒的常规筛查可能不是预测术后并发症风险婴儿的有效策略。
