P0390 - Fluid Balance and Acute Kidney Injury After Norwood Palliation: A Characterization and Implications for the First Five Postoperative Days

Objective: To identify the general trend in fluid overload during the first five days after the Norwood Procedure, to determine the prevalence of acute kidney injury (AKI) after the Norwood Procedure, and identify whether acute kidney injury correlates with specific outcomes, including AKI, ventilator days, delayed sternal closure, need for ECMO, or mortality.

Design: Single-center retrospective cohort study.

Setting: Pediatric cardiac intensive care unit, university-affiliated children’s hospital

Patients: 44 infants undergoing Norwood Procedure from 01/01/2011-12/31/2019.

Interventions: Using the congenital heart surgical database at the institution, all infants with single ventricle physiology from January 1, 2011 to December 31, 2019 were reviewed, and those who underwent a Norwood Procedure were included.

Measurements and Main

Results:
Forty-four patients meeting inclusion criteria were identified. Patient cohort data included demographics, clinical information, laboratory results, hemodynamic measurements, and fluid balance for post-operative days 1-5 after the Norwood Procedure. In this cohort, 13/41 (31.7%) of infants had AKI through Norwood post-operative day (POD) #5. All 13 patients had onset of AKI on POD #1 or #2, and all had stage one AKI. AKI was not significantly associated with preoperative factors such as age at Norwood, preop weight, preop bun, preop creatinine. Other than creatinine, no other marker was significantly associated with AKI on any POD (BUN, lactate, renal NIRS, fluid overload percent, fluid balance). AKI was not significantly associated with length of stay after Norwood, time to chest closure, or mechanical ventilation days. AKI was not significantly associated with need for ECMO, inpatient mortality, peritoneal dialysis catheter placement, or need for dialysis in this cohort.

Conclusion
AKI is a known complication following pediatric cardiac surgery. In this small cohort of post-operative Norwood Procedure infants, AKI was not significantly associated with length of stay, time to chest closure, mechanical ventilation days, need for ECMO, inpatient mortality, peritoneal catheter placement, or need for dialysis. Identifying factors that contribute to AKI and the outcomes associated with AKI will direct future treatment of these neonates. Investigating a larger cohort in addition to outcomes at other centers are necessary to clarify the impact of post-operative AKI on this neonatal population.