Pediatric physicians present 12 research abstracts, posters at Cardiology 2011

May 09, 2017

Newborns with pulmonary atresia and duct-dependent pulmonary blood flow often must receive surgery to implant a modified Blalock-Taussig (MBT) shunt. The shunt improves pulmonary blood circulation until a subsequent surgery repairs the heart defect. A study team led by Martin Zahorec, M.D., of the National Institute of Cardiovascular Diseases in Slovakia compared the results of closing vs. not closing the patent ductus arteriosus during MBT shunt surgery. In this retrospective observational study, the researchers studied 62 neonates who underwent primary MBT shunt surgery for pulmonary atresia at their institution from 1997 to 2010. The surgeons closed the PDA in 31 patients and left it open in 31 patients. Newborns in the duct closure group had higher mortality 48 hours post-surgery, as well as more resuscitation events and more reinterventions, compared to the newborns whose ducts were left open. Martin Zahorec, M.D., et al, Surgical Ductal Closure Increases Early Mortality and Morbidity after Modified Blalock-Taussig Shunt in Neonates with Pulmonary Atresia

Amount of Vasoactive Drugs Helps Predict Early Outcomes after Infant Heart Surgery

In evaluating early clinical outcomes following neonatal heart surgery, clinicians have used two markers: low cardiac output syndrome (LCOS) and maximum vasoactive inotropic score (VIS). The current study aimed to compare these markers to each other and to early clinical outcomes. Ryan Butts, M.D., and colleagues at the Medical University of South Carolina prospectively studied 76 newborns receiving heart surgery that required cardiopulmonary bypass. During the first 36 hours after surgery, the researchers used records of all vasoactive medications to calculate the VIS??”an indicator of the level of cardiovascular support. Higher VIS correlated with a longer duration of mechanical ventilation, longer ICU stay and higher hospital charges. Correlations between these outcomes and LCOS scores were not significant, suggesting that VIS is a better surrogate marker than LCOS for important early postsurgical outcomes.

Ryan Butts, M.D., et al, Maximum Vasoactive Inotropic Score Is Superior to Low Cardiac Output Syndrome as a Predictor of Early Outcomes Following Neonatal Cardiac Operations

Respiratory Therapists' Protocol Improves Care and Outcomes for Children in Pediatric Cardiac ICUs after Surgery

Using respiratory therapist-driven protocols for respiratory care in the ICU has been shown to be safe and to reduce both ventilator time and ICU length of stay. However, studies have not been reported on the safety and efficacy of such protocols in pediatric heart surgery patients. Researchers at St. Joseph's Hospital and Medical Center in Phoenix, led by Courtney Howell, CPNP, evaluated a newly instituted, respiratory-therapist-driven respiratory care protocol at their hospital. In a retrospective chart review, they analyzed seven outcomes in 267 children after cardiac surgery. There were 145 patients who received care in the six months before the protocols were instituted, compared to 122 patients in the post-protocol group. In the post-protocol group, the study team found a dramatic reduction in postoperative length of intubation (10 hours vs. 22 hours in the pre-protocol group) and a drastic reduction in the number of patients receiving mechanical ventilation longer than 7 days (7% vs. 1%). Other outcomes (mortality, postoperative pneumonia, pneumothorax, and need for reintubation) all trended downward, but were not statistically different between both groups.

Courtney Howell, CPNP, et al, Safety and Efficacy of Respiratory Therapist-Driven Respiratory Care Protocols in a Pediatric Cardiothoracic Intensive Care Unit

QI Program Cuts Infections from Implanting Pacemakers and Defibrillators in Children

Cardiac implantable device-related infection (CDI) is a significant complication of treating patients for cardiac arrhythmias. However, clinical practices and guidelines to minimize CDI have not yet been established. Jamie Ganley, R.N., and colleagues at The Children's Hospital of Philadelphia evaluated the efficacy of institutionally developed practice guidelines in reducing CDI in a cohort of pediatric and congenital heart disease patients who received pacemakers or implantable cardioverter defibrillators at their hospital. The guidelines specified the application of indicated antiseptics and antibiotics at particular times before device implantation. In this single-institution study of 309 patients, adherence to the guidelines significantly reduced the incidence of cardiac device infections, from 15% in the year before the guidelines were implemented, to 4.7% in the subsequent year. All the infections during the study period (19 in 309 patients) were in pacemaker implantations, with no infections from implantable cardioverter defibrillators.

Jamie Ganley, RN, et al, Establishing Institutional Practice Guidelines to Reduce Cardiac Implantable Device Infections: An Endeavor in Quality Improvement

Hypertension in Pulmonary Arteries Is Worse in Adults than in Children

REVEAL is the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management, a multicenter, observational U.S. study. Robyn Barst, M.D., of Columbia University College of Physicians and Surgeons, led a team that compared the characteristics of children and adults diagnosed with idiopathic pulmonary arterial hypertension (IPAH). The researchers analyzed records from 1,386 patients with IPAH, of which 1,287 had adult-onset IPAH and 99 had childhood-onset IPAH. The patients with adult-onset IPAH had worse hemodynamics and were in a worse functional class at diagnosis compared to patients with childhood-onset IPAH, despite the fact that the childhood-onset group had more presyncope and syncope. Adult-onset patients start treatment significantly earlier after diagnosis than the childhood-onset patients. For both groups, only a minority of patients receive acute vasoreactivity testing (AVT), despite a considerable number of patients receiving calcium-channel blocker therapy without AVT.

Robyn Barst, M.D., et al, REVEAL Registry: Comparison of Patients with Childhood-Onset and Adult-Onset Idiopathic Pulmonary Arterial Hypertension

SOURCE The Children's Hospital of Philadelphia