Kwiatkowski David M, Alten Jeffrey A, Raymond Tia T, Selewski David T, Blinder Joshua J, Afonso Natasha S, Coghill Matthew T, Cooper David S, Koch Joshua D, Krawczeski Catherine D, Mah Kenneth E, Neumayr Tara M, Rahman A K M Fazlur, Reichle Garret, Tabbutt Sarah, Webb Tennille N, Borasino Santiago
Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Cardiol Young. 2024 Feb;34(2):272-281. doi: 10.1017/S104795112300135X. Epub 2023 Jun 20.
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.
在一些中心，使用腹膜导管进行预防性透析或引流以预防新生儿心脏手术后的液体超负荷很常见；然而，腹膜导管使用的多中心差异及细节尚未得到充分描述。
一项由22个中心参与的新生儿和儿科心脏肾脏结局网络（NEPHRON）研究，旨在描述在使用体外循环进行STAT 3 - 5级新生儿心脏手术后多中心腹膜导管的使用情况。在三个队列中描述了患者特征以及术后六天的急性肾损伤/液体相关结局：接受透析的腹膜导管组、被动引流的腹膜导管组和未使用腹膜导管组。
在1490例新生儿中，471例（32%）在术中放置了腹膜导管；177例（12%）接受了预防性透析，294例（20%）接受了被动引流。16个（73%）中心在一定频率下使用腹膜导管，其中6个中心在超过50%的新生儿中使用。4个中心采用预防性腹膜透析。术后开始透析的时间为3小时[1, 5]，持续时间为56小时[37, 90]；被动引流队列的引流时间为92小时[64, 163]。腹膜导管在术前接受机械通气、单心室生理状态以及手术复杂性较高的患者中更为常见。与不良事件无关联。术后任何一天血清肌酐和每日液体平衡在临床上无差异。死亡率相似。
在接受复杂心脏手术的新生儿中，腹膜导管的使用并不罕见，各中心之间存在显著差异。手术复杂性越高，腹膜导管的使用越普遍。使用腹膜导管时不良事件发生率，包括死亡率，并无差异。腹膜导管组的液体超负荷和基于肌酐的急性肾损伤发生率无差异。
