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Conjugated hyperbilirubinemia is associated with increased morbidity and mortality after neonatal heart surgery
Mallory Hunt1, Iris E M de Jong2, Rebecca G Wells2
1Division of Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Insights
Conjugated hyperbilirubinemia after neonatal heart surgery is linked to increased complications and mortality. This condition, affecting 8.5% of patients, indicates a need for further investigation into its underlying mechanisms.
Area of Science:
- Neonatal Cardiology
- Pediatric Hepatology
- Critical Care Medicine
Background:
- Cholestasis, marked by conjugated hyperbilirubinemia, signifies hepatobiliary dysfunction in neonates post-cardiac surgery.
- Understanding its incidence and impact is crucial for improving outcomes in this vulnerable population.
Purpose of the Study:
- To determine the incidence of conjugated hyperbilirubinemia following neonatal heart surgery.
- To investigate the association between conjugated hyperbilirubinemia and post-operative morbidity and mortality.
Main Methods:
- Retrospective analysis of neonates undergoing congenital heart disease (CHD) surgery (2010-2020).
- Defined conjugated hyperbilirubinemia as perioperative conjugated bilirubin > 1 mg/dL.
- Utilized Kaplan-Meier survival analysis for in-hospital mortality.
Main Results:
- Conjugated hyperbilirubinemia occurred in 8.5% of patients.
- Associated with younger gestational age, lower birth weight, non-Caucasian race, chromosomal/non-cardiac anomalies, and pre-operative ECMO.
- Increased in-hospital mortality (OR 5.4) and post-operative complications; 1-year survival was 6% for bilirubin levels >10 mg/dL.
Conclusions:
- Conjugated hyperbilirubinemia is a significant predictor of post-operative complications and reduced survival post-neonatal heart surgery.
- Higher incidence in neonates with chromosomal and non-cardiac anomalies warrants further mechanistic research.
Background:
Cholestasis characterised by conjugated hyperbilirubinemia is a marker of hepatobiliary dysfunction following neonatal cardiac surgery. We aimed to characterise the incidence of conjugated hyperbilirubinemia following neonatal heart surgery and examine the effect of conjugated hyperbilirubinemia on post-operative morbidity and mortality.
Methods:
This was a retrospective study of all neonates who underwent surgery for congenital heart disease (CHD) at our institution between 1/1/2010 and 12/31/2020. Patient- and surgery-specific data were abstracted from local registry data and review of the medical record. Conjugated hyperbilirubinemia was defined as perioperative maximum conjugated bilirubin level > 1 mg/dL. The primary outcome was in-hospital mortality. Survival analysis was conducted using the Kaplan-Meier survival function.
Results:
Conjugated hyperbilirubinemia occurred in 8.5% of patients during the study period. Neonates with conjugated hyperbilirubinemia were more likely to be of younger gestational age, lower birth weight, and non-Caucasian race (all p < 0.001). Patients with conjugated hyperbilirubinemia were more likely to have chromosomal and non-cardiac anomalies and require ECMO pre-operatively. In-hospital mortality among patients with conjugated hyperbilirubinemia was increased compared to those without (odds ratio 5.4). Post-operative complications including mechanical circulatory support, reoperation, prolonged ventilator dependence, and multi-system organ failure were more common with conjugated hyperbilirubinemia (all p < 0.04). Patients with higher levels of conjugated bilirubin had worst intermediate-term survival, with patients in the highest conjugated bilirubin group (>10 mg/dL) having a 1-year survival of only 6%.
Conclusions:
Conjugated hyperbilirubinemia is associated with post-operative complications and worse survival following neonatal heart surgery. Cholestasis is more common in patients with chromosomal abnormalities and non-cardiac anomalies, but the underlying mechanisms have not been delineated.
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