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Predictors of early peritoneal dialysis initiation in newborns and young infants following cardiac surgery

Published online by Cambridge University Press:  02 January 2024

Elvia Rivera-Figueroa ,
Md Abu Yusuf M Ansari ,
Emily Turner Mallory ,
Padma Garg  and
Ali Mirza Onder Open the ORCID record for Ali Mirza Onder [Opens in a new window]
Elvia Rivera-Figueroa*
Affiliation:
Division of Pediatric Critical Care, Batson Children’s Hospital of Mississippi, University of Mississippi, Jackson, MS, USA Division of Pediatric Critical Care, Puerto Rico Women’s and Children’s Hospital, Ponce Health Sciences University, Bayamon, Puerto Rico
Md Abu Yusuf M Ansari
Affiliation:
Department of Data Science, University of Mississippi Medical Center, Jackson, MS, USA
Emily Turner Mallory
Affiliation:
University of Mississippi, Medical School, Jackson, MS, USA
Padma Garg
Affiliation:
Division of Pediatric Critical Care, Batson Children’s Hospital of Mississippi, University of Mississippi, Jackson, MS, USA
Ali Mirza Onder
Affiliation:
Division of Pediatric Nephrology, Batson Children’s Hospital of Mississippi, University of Mississippi, Jackson, MS, USA Division of Pediatric Nephrology, Nemours Children’s Health, Wilmington, DE, USA
*
Corresponding author: E. Rivera-Figueroa; Email: [email protected]
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Abstract

Objective:

This single-centre, retrospective cohort study was conducted to investigate the predictors of early peritoneal dialysis initiation in newborns and young infants undergoing cardiac surgery.

Methods:

There were fifty-seven newborns and young infants. All subjects received peritoneal dialysis catheter after completion of the cardiopulmonary bypass. Worsening post-operative (post-op) positive fluid balance and oliguria (<1 ml/kg/hour) despite furosemide were the clinical indications to start early peritoneal dialysis (peritoneal dialysis +). Demographic, clinical, and laboratory data were collected from the pre-operative, intra-operative, and immediately post-operative periods.

Results:

Baseline demographic data were indifferent except that peritoneal dialysis + group had more newborns. Pre-operative serum creatinine was higher for peritoneal dialysis + group (p = 0.025). Peritoneal dialysis + group had longer cardiopulmonary bypass time (p = 0.044), longer aorta cross-clamp time (p = 0.044), and less urine output during post-op 24 hours (p = 0.008). In the univariate logistic regression model, pre-op serum creatinine was significantly associated with higher odds of being in peritoneal dialysis + (p = 0.021) and post-op systolic blood pressure (p = 0.018) and post-op mean arterial pressure (p=0.001) were significantly associated with reduced odds of being in peritoneal dialysis + (p = 0.018 and p = 0.001, respectively). Post-op mean arterial pressure showed a statistically significant association adjusted odds ratio = 0.89, 95% confidence interval [0.81, 0.96], p = 0.004) with peritoneal dialysis + in multivariate analysis after adjusting for age at surgery.

Conclusions:

In our single-centre cohort, pre-op serum creatinine, post-op systolic blood pressure, and mean arterial pressure demonstrated statistically significant association with peritoneal dialysis +. This finding may help to better risk stratify newborns and young infants for early peritoneal dialysis start following cardiac surgery.

Keywords

congenital heart surgeryperitoneal dialysisurine outputnewbornfluid overload
Type
Original Article
Information
Cardiology in the Young , Volume 34 , Issue 6 , June 2024 , pp. 1239 - 1246
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Copyright
© The Author(s), 2024. Published by Cambridge University Press

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