Acute kidney injury in children after cardiopulmonary bypass: risk factors and outcome.

OBJECTIVE: To determine the incidence, risk factors and outcomes of acute kidney injury in children undergoing cardiac surgery for congenital heart disease. METHODS: We enrolled 208 patients undergoing cardiac surgery for congenital heart disease during January 2012 to March 2013. Acute kidney injury was defined as per Acute Kidney Injury Network criteria. RESULTS: Twenty patients had Acute kidney injury; 14 were infants. Age <1 yr, cardiopulmonary bypass time, prolonged ventilator requirement, pump failure, sepsis and hematological complications were identified as independent risk factors for any degree for acute kidney injury. All patients with acute kidney injury recovered the kidney function at the time of discharge. CONCLUSIONS: Acute kidney injury is common in children after cardiac surgery, especially in infants.

Vasoactive Inotrope Score as a tool for clinical care in children post cardiac surgery.

BACKGROUND: Neonates and infants undergoing heart surgery on cardiopulmonary bypass (CPB) are at high risk for significant post-operative morbidity and mortality. Hence, there is a need to identify and quantify clinical factors during the early post-operative period that are indicative of short-term as well as long-term outcomes. Multiple inotrope scores have been used in practice to quantify the amount of cardiovascular support received by neonates. AIMS: The goal of this study was to determine the association between inotropic/vasoactive support and clinical outcomes in children after open cardiac surgery. MATERIALS AND METHODS: This is a retrospective analysis of the 208 patients who underwent cardiac surgery for congenital heart disease at a tertiary pediatric cardiac surgery Intensive Care Unit (ICU) from January 2012 to March 2013. Multiple demographic, intra-operative and post-operative variables were recorded, including the Vasoactive Inotrope Score (VIS). RESULTS: A total of 208 patients underwent cardiac surgery for congenital heart disease in the study period. The mean age and weight in the study were 66.94 months and 16.31 kg, respectively. Statistically significant associations were found in the various variables and VIS, including infancy, weight < 10 kg, CPB time, pump failure and post-operative variables like sepsis, hematological complications, hepatic dysfunction, acute kidney injury during admission, mortality, prolonged ventilator requirement, CPB time (in min) and hospital stay. CONCLUSIONS: Inotrope score and its adaptations are an excellent tool to measure illness severity, deciding interventions and during parental counseling in the pediatric cardiac surgery ICUs.