Role of early peritoneal dialysis after neonatal arterial switch operation

Peritoneal dialysis (PD) commenced early in the postoperative period has the potential to mitigate the postcardiopulmonary bypass inflammatory response. We evaluated the role of early PD on postoperative outcomes after the arterial switch operation (ASO).

Newborns (≤30 days, n = 318) undergoing ASO were classified into those who did (early PD, n = 90) or did not (control, n = 228) receive PD within 6 hours of admission to intensive care unit after surgery. Using observational data and imitating a preplanned clinical trial (target trial framework), we evaluated the role of early PD on postoperative outcomes.

Infants in the early PD group had greater serum lactate (median [interquartile range]: 2.6 [2.1, 4.1] vs 2.2 [1.8, 2.9]) and lower central venous saturation (median [interquartile range]: 45.2 [39.3, 51.4] vs 51.3 [42.2, 59.9]) at admission. Early PD was associated with a shorter duration of mechanical ventilation, but this effect was restricted to the subgroup receiving extracorporeal membrane oxygenation (ECMO) in the perioperative period (incidence rate ratio [95% confidence interval]: for early PD/control: 0.28 [0.17-0.47] for those requiring ECMO and 1.14 [0.93-1.39] for those not requiring ECMO, P interaction <.001). Similar results were seen for intensive care unit length of stay.

Early PD after ASO was associated with a reduction in duration of mechanical ventilation and intensive care stay for infants who required ECMO in the perioperative period. Future studies of early PD, ideally clinical trials, in high-risk infants (such as those requiring ECMO after cardiac surgery) will be of benefit to either confirm or refute these findings.