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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.
Prolonged noninvasive respiratory support (NRS) is common in neonates after the Norwood procedure. Factors like airway anomalies and reinterventions are linked to longer NRS use and worse outcomes.
Area of Science:
- Pediatric Cardiology
- Neonatal Intensive Care
- Respiratory Support
Background:
- The Norwood procedure is a critical intervention for single-ventricle neonates.
- Optimal post-extubation respiratory support strategies remain unclear.
Purpose of the Study:
- To investigate patterns of respiratory support after extubation in neonates undergoing the Norwood procedure.
- To identify factors associated with prolonged noninvasive respiratory support (NRS) use (≥72 hours).
Main Methods:
- Retrospective cohort study in North American pediatric cardiac ICUs.
- Included neonates (<1 month old) who underwent the Norwood procedure (2019-2023).
- Analyzed factors associated with prolonged NRS and clinical outcomes.
Main Results:
- 47% of 127 neonates required prolonged NRS.
- Airway anomalies, reinterventions, and longer mechanical ventilation were linked to prolonged NRS.
- Prolonged NRS was associated with lower weight-for-age z-scores, longer CICU stays, and increased sedative exposure.
Conclusions:
- Prolonged NRS is a frequent occurrence in neonates post-Norwood procedure.
- Longer NRS use correlates with poorer clinical outcomes, including growth and resource utilization.
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