Modified Ultrafiltration and Association with Outcomes after Neonatal Cardiac Surgery

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Critical Care Medicine

Background:

• Neonatal cardiopulmonary bypass (CPB) carries risks, including fluid overload.
• Modified ultrafiltration (MUF) is a technique used to manage fluid balance during CPB.

Purpose of the Study:

• To evaluate the association of modified ultrafiltration (MUF) with outcomes in neonates undergoing cardiopulmonary bypass (CPB) in the current era.

Main Methods:

• Retrospective analysis of 1,654 neonates from the PC4/NEPHRON dataset (2015-2018).
• Stratification of neonates based on MUF use and comparison of outcomes.
• Multivariable regression models adjusted for center-specific MUF use and high-risk covariates.

Main Results:

• MUF was used in 60% of neonates and was associated with lower early postoperative fluid accumulation.
• No significant differences were observed in mortality, duration of invasive ventilation, length of stay, or bleeding between MUF and non-MUF groups.
• Multivariable analysis showed MUF use increased the likelihood of achieving a negative fluid balance by postoperative day 3.

Conclusions:

• Modified ultrafiltration (MUF) use in neonatal cardiopulmonary bypass (CPB) is linked to reduced early postoperative fluid accumulation.
• MUF did not demonstrate significant improvements in mortality, ventilation duration, or length of hospital stay.