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Sternal wound and mediastinal infections in infants with congenital heart disease

B Kearns1, C Sabella, R B Mee

  • 1Division of Pediatrics, The Cleveland Clinic Children's Hospital, OH 44195, USA.

Cardiology in the Young
|July 1, 1999
PubMed

Insights

Sternal wound and mediastinal infections in infants undergoing congenital heart surgery are often caused by Staphylococcus. These infections can be chronic, leading to delayed surgical repair.

Area of Science:

  • Pediatric Surgery
  • Infectious Diseases
  • Cardiology

Background:

  • Congenital heart disease (CHD) necessitates palliative or repair procedures in infants.
  • Sternal wound and mediastinal infections (SWMI) are serious complications following cardiac surgery in neonates.
  • Early diagnosis and management of SWMI are crucial for patient outcomes.

Purpose of the Study:

  • To delineate the epidemiologic, clinical, bacteriologic, and therapeutic characteristics of SWMI in infants.
  • To identify risk factors and clinical presentations of SWMI in neonates undergoing CHD surgery.
  • To evaluate treatment strategies and outcomes for SWMI in this vulnerable population.

Main Methods:

  • Retrospective chart review of seven infants diagnosed with SWMI post-CHD surgery.
  • Analysis of patient demographics, surgical history, infection presentation, causative pathogens, and treatment regimens.
  • Categorization of infections into superficial sternal or deep mediastinal types.

Main Results:

  • All affected infants were under 30 days old at initial surgery; most had hypoplastic left heart syndrome.
  • Superficial sternal infections presented earlier (mean 12 days post-op), while deep mediastinal infections were often asymptomatic until a second surgery (mean 120 days post-op).
  • Staphylococcus aureus or coagulase-negative Staphylococcus was the predominant pathogen; all mediastinal infections required operative debridement and long-term antibiotics.

Conclusions:

  • SWMI in infants undergoing staged palliative procedures for CHD can be chronic and indolent.
  • Delayed diagnosis of deep mediastinal infections may occur due to asymptomatic presentation.
  • Effective management involves prompt surgical debridement and prolonged antibiotic therapy, though repair delays are common.

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