Observational Study

. 2022 Dec;114(6):2288-2294.

doi: 10.1016/j.athoracsur.2021.12.078. Epub 2022 Mar 1.

Fluid Accumulation After Neonatal Congenital Cardiac Operation: Clinical Implications and Outcomes

Collaborators, Affiliations

Collaborators

NEPHRON Investigators:
Parthak Prodhan¹³, Xiomara Garcia¹³, Shannon Ramer¹³, Mindy Albertson¹³, Muhammad B Ghbeis¹⁴, David S Cooper¹⁵, Zahidee Rodriquez¹⁵, Mary Lukacs¹⁵, Dominic Zanaboni¹⁶, Joan Sanchez de Toledo¹⁷, Yuliya A Domnina¹⁷, Lucas Saenz¹⁷, Tracy Baust¹⁷, Jane Kluck¹⁸, Linda Duncan¹⁸, Joshua D Koch¹⁹, Joshua Freytag²⁰, Amanda Sammons²⁰, Hideat Abraha²⁰, John Butcher²⁰, Jun Sasaki²¹, Catherine D Krawczeski²², Rebecca A Bertrandt²³, Tia T Raymond²⁴, Jason R Buckley²⁵, Luke Schroeder²⁵, Aanish Raees²⁶, Lisa J Sosa²⁷, Priya N Bhat²⁸, Tara M Neumayr²⁹, Natasha S Afonso³⁰, Erika R O'Neal³⁰, Javier J Lasa³⁰, Patrick A Phillips³¹, Amy Ardisana³², Kim Gonzalez³², Tammy Doman³², Suzanne Viers³², Wenying Zhang³³, Kristal M Hock³⁴, Santiago Borasino³⁴

Affiliations

¹ Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City, Utah. Electronic address: david.bailly@hsc.utah.edu.
² Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
³ Department of Pediatrics, The Heart Institute, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
⁴ Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.
⁵ Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana.
⁶ Division of Cardiac Critical Care Medicine, Children's National Hospital, Washington, DC.
⁷ Department of Pediatrics, University of Tennessee College of Medicine, Le Bonheur Children's Hospital, Memphis Tennessee.
⁸ Department of Pediatrics, Sibley Heart Center Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
⁹ Division of Pediatric Nephrology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.
¹⁰ Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan.
¹¹ Pediatric Cardiac Critical Care Consortium, Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan.
¹² Division of Cardiac Critical Care Medicine, Department of Anesthesia/Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
¹³ Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
¹⁴ Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
¹⁵ Division of Pediatric Cardiology, The Heart Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
¹⁶ Division of Cardiac Critical Care Medicine, Department of Anesthesia/Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
¹⁷ Department of Critical Care Medicine and Pediatrics, UMPC Children's Hospital of Pittsburg, University of Pittsburg School of Medicine, Pittsburg, Pennsylvania.
¹⁸ Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
¹⁹ Division of Critical Care Medicine, Department of Pediatrics, Children's Medical Center of Dallas, University of Texas Southwestern Medical School, Dallas, Texas.
²⁰ Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
²¹ Division of Cardiac Critical Care Medicine, Nicklaus Children's Hospital, Miami, Florida.
²² Lucile Packard Children's Hospital Stanford, Palo Alto, California; Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio.
²³ Division of Critical Care, Department of Pediatrics, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin.
²⁴ Department of Pediatric Cardiology, Medical City Children's Hospital, Dallas, Texas.
²⁵ Medical University of South Carolina Children's Hospital, Charleston, South Carolina.
²⁶ Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt, Tennessee.
²⁷ Nicklaus Children's Hospital, Miami, Florida.
²⁸ St. Louis Children's Hospital, St. Louis, Missouri; Division of Pediatric Critical Care, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
²⁹ St. Louis Children's Hospital, St. Louis, Missouri; Division of Pediatric Critical Care Medicine and Division of Pediatric Nephrology, Department of Pediatrics, Washington University of St. Louis, St Louis, Missouri.
³⁰ Pediatric Critical Care, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
³¹ Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama.
³² CS Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan.
³³ Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
³⁴ Section of Cardiac Critical Care Medicine, Department of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, Alabama.

PMID: 35245511
PMCID: PMC9433462
DOI: 10.1016/j.athoracsur.2021.12.078

Observational Study

Fluid Accumulation After Neonatal Congenital Cardiac Operation: Clinical Implications and Outcomes

David K Bailly et al. Ann Thorac Surg. 2022 Dec.

. 2022 Dec;114(6):2288-2294.

doi: 10.1016/j.athoracsur.2021.12.078. Epub 2022 Mar 1.

Authors

Collaborators

NEPHRON Investigators:
Parthak Prodhan¹³, Xiomara Garcia¹³, Shannon Ramer¹³, Mindy Albertson¹³, Muhammad B Ghbeis¹⁴, David S Cooper¹⁵, Zahidee Rodriquez¹⁵, Mary Lukacs¹⁵, Dominic Zanaboni¹⁶, Joan Sanchez de Toledo¹⁷, Yuliya A Domnina¹⁷, Lucas Saenz¹⁷, Tracy Baust¹⁷, Jane Kluck¹⁸, Linda Duncan¹⁸, Joshua D Koch¹⁹, Joshua Freytag²⁰, Amanda Sammons²⁰, Hideat Abraha²⁰, John Butcher²⁰, Jun Sasaki²¹, Catherine D Krawczeski²², Rebecca A Bertrandt²³, Tia T Raymond²⁴, Jason R Buckley²⁵, Luke Schroeder²⁵, Aanish Raees²⁶, Lisa J Sosa²⁷, Priya N Bhat²⁸, Tara M Neumayr²⁹, Natasha S Afonso³⁰, Erika R O'Neal³⁰, Javier J Lasa³⁰, Patrick A Phillips³¹, Amy Ardisana³², Kim Gonzalez³², Tammy Doman³², Suzanne Viers³², Wenying Zhang³³, Kristal M Hock³⁴, Santiago Borasino³⁴

Affiliations

¹ Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City, Utah. Electronic address: david.bailly@hsc.utah.edu.
² Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
³ Department of Pediatrics, The Heart Institute, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
⁴ Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.
⁵ Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana.
⁶ Division of Cardiac Critical Care Medicine, Children's National Hospital, Washington, DC.
⁷ Department of Pediatrics, University of Tennessee College of Medicine, Le Bonheur Children's Hospital, Memphis Tennessee.
⁸ Department of Pediatrics, Sibley Heart Center Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
⁹ Division of Pediatric Nephrology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.
¹⁰ Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan.
¹¹ Pediatric Cardiac Critical Care Consortium, Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan.
¹² Division of Cardiac Critical Care Medicine, Department of Anesthesia/Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
¹³ Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
¹⁴ Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
¹⁵ Division of Pediatric Cardiology, The Heart Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
¹⁶ Division of Cardiac Critical Care Medicine, Department of Anesthesia/Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
¹⁷ Department of Critical Care Medicine and Pediatrics, UMPC Children's Hospital of Pittsburg, University of Pittsburg School of Medicine, Pittsburg, Pennsylvania.
¹⁸ Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
¹⁹ Division of Critical Care Medicine, Department of Pediatrics, Children's Medical Center of Dallas, University of Texas Southwestern Medical School, Dallas, Texas.
²⁰ Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
²¹ Division of Cardiac Critical Care Medicine, Nicklaus Children's Hospital, Miami, Florida.
²² Lucile Packard Children's Hospital Stanford, Palo Alto, California; Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio.
²³ Division of Critical Care, Department of Pediatrics, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin.
²⁴ Department of Pediatric Cardiology, Medical City Children's Hospital, Dallas, Texas.
²⁵ Medical University of South Carolina Children's Hospital, Charleston, South Carolina.
²⁶ Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt, Tennessee.
²⁷ Nicklaus Children's Hospital, Miami, Florida.
²⁸ St. Louis Children's Hospital, St. Louis, Missouri; Division of Pediatric Critical Care, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
²⁹ St. Louis Children's Hospital, St. Louis, Missouri; Division of Pediatric Critical Care Medicine and Division of Pediatric Nephrology, Department of Pediatrics, Washington University of St. Louis, St Louis, Missouri.
³⁰ Pediatric Critical Care, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
³¹ Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama.
³² CS Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan.
³³ Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
³⁴ Section of Cardiac Critical Care Medicine, Department of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, Alabama.

PMID: 35245511
PMCID: PMC9433462
DOI: 10.1016/j.athoracsur.2021.12.078

Abstract

Background: This study was conducted to determine the association between fluid balance metrics and mortality and other postoperative outcomes after neonatal cardiac operation in a contemporary multicenter cohort.

Methods: This was an observational cohort study across 22 hospitals in neonates (≤30 days) undergoing cardiac operation. We explored overall percentage fluid overload, postoperative day 1 percentage fluid overload, peak percentage fluid overload, and time to first negative daily fluid balance. The primary outcome was in-hospital mortality. Secondary outcomes included postoperative duration of mechanical ventilation and intensive care unit (ICU) and hospital length of stay. Multivariable logistic or negative binomial regression was used to determine independent associations between fluid overload variables and each outcome.

Results: The cohort included 2223 patients. In-hospital mortality was 3.9% (n = 87). Overall median peak percentage fluid overload was 4.9% (interquartile range, 0.4%-10.5%). Peak percentage fluid overload and postoperative day 1 percentage fluid overload were not associated with primary or secondary outcomes. Hospital resource utilization increased on each successive day of not achieving a first negative daily fluid balance and was characterized by longer duration of mechanical ventilation (incidence rate ratio, 1.11; 95% CI, 1.08-1.14), ICU length of stay (incidence rate ratio, 1.08; 95% CI, 1.03-1.12), and hospital length of stay (incidence rate ratio, 1.09; 95% CI, 1.05-1.13).

Conclusions: Time to first negative daily fluid balance, but not percentage fluid overload, is associated with improved postoperative outcomes in neonates after cardiac operation. Specific treatments to achieve an early negative fluid balance may decrease postoperative care durations.

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Figures

**Figure 1.**
Cohort distribution of peak % fluid overload.

**Figure 2.**
Median peak % fluid overload by center.

**Figure 3.**
Median % fluid overload by center and postoperative day.

See this image and copyright information in PMC

Comment in

The Journey to a Negative Fluid Balance in Pediatric Cardiac Critical Care.
Hoffman TM. Hoffman TM. Ann Thorac Surg. 2022 Dec;114(6):2294-2295. doi: 10.1016/j.athoracsur.2022.01.065. Epub 2022 Feb 26. Ann Thorac Surg. 2022. PMID: 35231435 No abstract available.

References

1. Mah KE, Hao S, Sutherland SM, Kwiatkowski DM, Axelrod DM, Almond CS, et al. Fluid overload independent of acute kidney injury predicts poor outcomes in neonates following congenital heart surgery. Pediatr Nephrol 2018;33:511–20. 10.1007/s00467-017-3818-x. - DOI - PubMed
1. Piggott KD, Soni M, Decampli WM, Ramirez JA, Holbein D, Fakioglu H, et al. Acute Kidney Injury and Fluid Overload in Neonates Following Surgery for Congenital Heart Disease. World J Pediatr Congenit Heart Surg 2015;6:401–6. 10.1177/2150135115586814. - DOI - PubMed
1. Wilder NS, Yu S, Donohue JE, Goldberg CS, Blatt NB. Fluid Overload Is Associated With Late Poor Outcomes in Neonates Following Cardiac Surgery. Ped Crit Care Med 2016;17:420–7. 10.1097/PCC.0000000000000715. - DOI - PMC - PubMed
1. Gist KM, Blinder JJ, Bailly D, Borasino S, Askenazi DJ, Cooper DS, et al. Neonatal and Paediatric Heart and Renal Outcomes Network: Design of a multi-centre retrospective cohort study. Cardiol Young 2019;29:511–8. 10.1017/S1047951119000210. - DOI - PubMed
1. Gaies M, Cooper DS, Tabbutt S, Schwartz SM, Ghanayem N, Chanani NK, et al. Collaborative quality improvement in the cardiac intensive care unit: development of the Paediatric Cardiac Critical Care Consortium (PC4). Cardiol Young 2014;25:1–7. 10.1017/S1047951114001450. - DOI - PMC - PubMed

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Fluid Accumulation After Neonatal Congenital Cardiac Operation: Clinical Implications and Outcomes

Collaborators

Affiliations

Fluid Accumulation After Neonatal Congenital Cardiac Operation: Clinical Implications and Outcomes

Authors

Collaborators

Affiliations

Abstract

Figures

Comment in

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical