Associate Professor Stanford University School of Medicine Palo Alto, California, United States
Abstract:
Introduction: Prophylactic peritoneal dialysis (prophylactic dialysis) and passive peritoneal drainage (drainage) without dialysis are used to prevent fluid overload in neonates after complex cardiac surgery in some centers. The Neonatal and Pediatric Heart Renal Outcomes Network (NEPHRON) is a multicenter collaborative formed to investigate acute kidney injury (AKI) after neonatal cardiac surgery. We proposed a preliminary investigation comparing neonates following high-complexity cardiac surgery with no peritoneal catheter to those with prophylactic dialysis and those with drainage.
Methods: Twenty-two Pediatric Cardiac Critical Care Consortium (PC4) centers participated in the NEPHRON data module between 9/2015 and 1/2018. Among neonates undergoing Society of Thoracic Surgeons (STS) STAT 5 cardiopulmonary bypass surgery, variables and outcomes were compared among 3 cohorts: (1) prophylactic dialysis, (2) drainage, and (3) no peritoneal catheter placement. Neonates undergoing peritoneal dialysis to treat AKI were excluded. Univariate results are presented.
Results: Among the 378 identified neonates, 145 (38%) received a peritoneal catheter intraoperatively, of whom 53 (14%) underwent prophylactic dialysis and 92 (24%) passive drainage. The median time to prophylactic dialysis initiation was 1.9 (0, 3.5) hours with a duration of 83 (51,130) hours. The timeframe of passive drainage was not captured. Table 1 demonstrates univariate comparisons between prophylactic dialysis, passive drainage and no peritoneal catheter. Peak percent fluid overload (mL/kg) was not different among cohorts: PPD: 4 (-1, 8); drainage: 5 (1, 8); no catheter: 3 (-1, 8). The prophylactic dialysis cohort had significantly lower duration of postoperative mechanical ventilation compared to the drainage cohort (120 vs. 160 hours, p=0.009), but not compared to the no catheter cohort (140 hours). There was no significant difference among the cohorts in duration of hospital stay or time to first negative daily fluid balance. Aggregate serum creatinine on POD 4-6 was significantly lower for both the PPD and passive drainage cohorts when compared to the no catheter cohort. There was no difference in recorded adverse events.
Conclusions: In the NEPHRON collaborative, in neonates undergoing STS STAT 5 surgery, peritoneal catheters were placed commonly. Prophylactic dialysis was associated with a shorter time to extubation compared to passive drainage. Otherwise, no difference in strategies was noted. Next steps include a risk adjusted multivariable analysis including center as a variable and mortality as an outcome.
