Related Experiment Video
Updated: Dec 22, 2025
Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
Published on: May 26, 2023
Risk factors and outcomes for hyperbilirubinaemia after heart surgery in children
Daniel M Pasternack1, Manal AlQahtani1, Rafael Zonana Amkie1
1Nicklaus Children's Hospital, Miami, FL, USA.
Insights
Post-operative hyperbilirubinaemia in infants after cardiac surgery is linked to extracorporeal membrane oxygenation and total parenteral nutrition. Elevated bilirubin levels indicate increased risk of mortality and prolonged hospital stays.
Area of Science:
- Pediatric Cardiology
- Neonatal Surgery
- Hepatology
Background:
- Liver dysfunction is a frequent complication in patients with congenital heart disease (CHD), contributing to significant morbidity and mortality.
- Hyperbilirubinaemia, particularly conjugated hyperbilirubinaemia, is a concern in neonates and infants following cardiac surgery.
Purpose of the Study:
- To investigate the risk factors associated with post-operative conjugated hyperbilirubinaemia in neonates and infants undergoing cardiac surgery.
- To determine the outcomes, including mortality and length of stay, associated with hyperbilirubinaemia in this patient population.
Main Methods:
- A retrospective analysis was conducted on neonates and infants who underwent cardiac surgery between January 2013 and December 2017.
- Conjugated hyperbilirubinaemia was identified post-operatively, and associations with demographic factors, surgical risk factors, and post-operative interventions were analyzed.
- The relationship between hyperbilirubinaemia and post-operative mortality and prolonged length of stay was also assessed.
Main Results:
- Of 242 post-operative admissions, 19% (45 patients) exhibited conjugated hyperbilirubinaemia, with average levels of 2.0 mg/dl compared to 0.3 mg/dl in controls.
- Post-operative use of extracorporeal membrane oxygenation (OR 4.97) and total parenteral nutrition (OR 2.98) were significantly associated with conjugated hyperbilirubinaemia.
- Hyperbilirubinaemia was independently associated with increased odds of mortality (OR 3.74) and prolonged length of stay (OR 2.87).
Conclusions:
- Post-operative use of total parenteral nutrition and extracorporeal membrane oxygenation are identified as risk factors for hyperbilirubinaemia after cardiac surgery.
- Patients with hyperbilirubinaemia face a higher likelihood of morbidity and mortality.
- Bilirubin levels may serve as a crucial marker for elevated risk of poor post-operative outcomes, warranting frequent monitoring after cardiac surgery.
Introduction:
Liver dysfunction, associated with morbidity and mortality, is common in patients with CHD. We investigate risk factors for and outcomes of hyperbilirubinaemia in neonates and infants after cardiac surgery.
Materials And Methods:
In a retrospective analysis of neonates and infants undergoing cardiac surgery at our institution between January 2013 and December 2017, we identified those with post-operative conjugated hyperbilirubinaemia. We tested various demographic and surgical risk factors, and use of post-operative interventions, for an association with conjugated hyperbilirubinaemia. We also tested hyperbilirubinaemia for association with post-operative mortality and prolonged length of stay.
Results:
We identified 242 post-operative admissions, of which 45 (19%) had conjugated hyperbilirubinaemia. The average conjugated bilirubin level in this group was 2.0 mg/dl versus 0.3 mg/dl for peers without hyperbilirubinaemia. The post-operative use of both extracorporeal membrane oxygenation (OR 4.97, 95% CI 1.89-13.5, p = 0.001) and total parenteral nutrition (OR 2.98, 95% CI 1.34-7.17, p = 0.010) was associated with conjugated hyperbilirubinaemia. No demographic variable analysed was found to be a risk factor. Hyperbilirubinaemia was associated with higher odds of mortality (OR 3.74, 95% CI 2.69-13.8, p = 0.005) and prolonged length of stay (OR 2.87, 95% CI 2.02-7.97, p = 0.005), which were independent of other risk factors.
Discussion:
We identified the post-operative use of total parenteral nutrition and extracorporeal membrane oxygenation as risk factors for hyperbilirubinaemia. These patients were more likely to experience morbidity and mortality than control peers. As such, bilirubin may be marker for elevated risk of poor post-operative outcomes and should be more frequently measured after cardiac surgery.
Related Concept Videos
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:26Diseases of the Liver and Gallbladder
Cirrhosis is characterized by the scarring of hepatic lobules in the liver, which are replaced by fibrous tissue, affecting the liver's normal functioning. NAFLD, on the other hand, is caused by an excessive build-up of fat in the liver, not...
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
01:26Kidney Transplant II: Surgical Procedure