Department of Neonatology, Istanbul Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, Istanbul, Turkey.
Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, Istanbul, Turkey.
Braz J Cardiovasc Surg. 2023 Aug 4;38(5):e20220442. doi: 10.21470/1678-9741-2022-0442.
In this study, we aimed to evaluate the factors affecting major adverse event (MAE) development after full-term neonatal cardiac surgery.
This study was conducted retrospectively on newborns who underwent congenital heart surgery between June 1, 2020, and June 1, 2022. MAE was defined as the presence of at least one of the following: cardiac arrest, unplanned reoperation, emergency chest opening, admission to the advanced life support system, and death. The role of blood lactate level, vasoactive inotropic score (VIS), and cerebral near-infrared spectroscopy (NIRS) changes in predicting MAE was investigated.
A total of 240 patients (50% male) were operated during the study period. The median age of patients was seven days (interquartile range 3-10 days). MAE was detected in 19.5% of the cases. Peak blood lactate levels >7 mmol/liter (area under the curve [AUC] 0.72, 95% confidence interval [CI] [0.62-0.82], P<0.001, sensitivity 76%, specificity 82%, positive predictive value [PPV] 88%) was an independent risk factor for MAE (odds ratio [OR] 2.7 [95% CI 1.3-6]). More than 30% change in NIRS value during the operative period (AUC 0.84, 95% CI [0.80-0.88], P<0.001, sensitivity 65%, specificity 85%, PPV 90%) was a strong predictor of MAE. VIS > 10 was an independent risk factor (AUC 0.75, 95% CI [0.70-0.84], P<0.001, sensitivity 86%, specificity 80%, PPV 84%) and strongly predicted MAE (OR 1.4 [95% CI 0.9-5]).
Cerebral NIRS changes > 30%, high blood lactate levels, and VIS score within the 48 hours may help to predict the development of MAE in the postoperative period.
本研究旨在评估影响足月新生儿心脏手术后主要不良事件（MAE）发生的因素。
本研究回顾性分析了 2020 年 6 月 1 日至 2022 年 6 月 1 日期间接受先天性心脏手术的新生儿。MAE 定义为至少出现以下一种情况：心脏骤停、计划外再次手术、紧急开胸、纳入高级生命支持系统和死亡。研究了血乳酸水平、血管活性正性肌力评分（VIS）和脑近红外光谱（NIRS）变化在预测 MAE 中的作用。
研究期间共对 240 例患者（50%为男性）进行了手术。患者的中位年龄为 7 天（四分位距 3-10 天）。19.5%的病例发生 MAE。血乳酸峰值>7mmol/L（曲线下面积[AUC]0.72，95%置信区间[CI]为[0.62-0.82]，P<0.001，敏感性 76%，特异性 82%，阳性预测值[PPV]为 88%）是 MAE 的独立危险因素（比值比[OR]为 2.7[95%CI为 1.3-6]）。手术期间 NIRS 值变化超过 30%（AUC 0.84，95%CI [0.80-0.88]，P<0.001，敏感性 65%，特异性 85%，PPV 90%）是 MAE 的强烈预测因素。VIS>10 是独立危险因素（AUC 0.75，95%CI [0.70-0.84]，P<0.001，敏感性 86%，特异性 80%，PPV 84%），强烈预测 MAE（OR 1.4[95%CI 0.9-5]）。
脑 NIRS 变化>30%、高血乳酸水平和 48 小时内的 VIS 评分可能有助于预测术后 MAE 的发生。
