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Associations With Prolonged Post-Extubation Noninvasive Respiratory Support in Neonates Following the Norwood
Joshua Feder1,2, Alejandro Floh2, Yuanyuan Fu1
1Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children's Hospital, Boston, MA.
Objective:
The use of post-extubation respiratory support in single-ventricle neonates undergoing the Norwood procedure is poorly described. We investigated the patterns of respiratory support following extubation as well as factors associated with prolonged exposure to post-extubation noninvasive respiratory support (NRS), defined as greater than or equal to 72 hours, in neonates recovering from the Norwood procedure.
Design:
Two-center retrospective cohort study.
Setting:
North American pediatric cardiac ICUs.
Patients:
Neonates (< 1 mo at the time of surgery) undergoing a Norwood procedure between January 1, 2019, and December 31, 2023.
Measurements And Main Results:
The study included 127 neonates of whom 60 (47%) experienced the primary outcome of prolonged NRS. In multivariable analysis, the presence of an airway anomaly (adjusted odds ratio [aOR] 3.6; 95% CI, 1.4-8.9; p = 0.006), an unplanned surgical or catheter-based reintervention (aOR 3.2; 95% CI, 1.3-7.5; p = 0.010), and longer postoperative mechanical ventilation (aOR 1.1; 95% CI, 1.0-1.2; p = 0.018) were independently associated with prolonged NRS. Patients with prolonged NRS had lower weight-for-age z score at cardiac ICU (CICU) discharge (-2.11 vs. -1.14; p = 0.004), longer CICU length of stay (25.1 vs. 11.1 d; p < 0.001), and longer postoperative sedative exposure (59.8 vs. 16.8 d; p < 0.001).
Conclusions:
Prolonged NRS is common in neonates following the Norwood procedure. Patients receiving prolonged NRS experience worse clinical outcomes.
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