Affiliations: Department of Clinical Epidemiology, Children's
Hospital of Mexico, Faculty of Medicine UNAM3, Mexico City, Mexico | Medical Research Unit in Clinical Epidemiology,
Hospital de Especialidades CMN SXXI, IMSS, Medical Science Research Center,
UAEMEX, Mexico City, Mexico | Department of Pediatric Intensive Care Unit, National
Cardiology Institute "Ignacio Chávez", Mexico City, Mexico
Note: [] Correspondence: Dr. Vivanco Mu\~{n}oz Nalleli, Márquez
No.162 Col. Doctores Del. Cuauhtemoc, CP06720 Mexico City, Mexico. Tel.: +152
55 56 83 91 67; E-mail: [email protected]
Abstract: Nosocomial infections at pediatric intensive care units (PICUs)
often lead to substantial morbidity, mortality, and prolonged hospital stays in
children who have open-heart surgery. Little is known about the risk factors in
this population. Our aim was to identify the incidence and clinical factors
associated with infections at the PICU in children with congenital heart
disease after surgery. Clinical records of patients ⩽ 3-year-old with
congenital heart disease, admitted for surgery, were evaluated for clinical,
nutritional, and other risk factors. Infection was determined during the
patient's stay at the PICU. Two hundred eighty-nine patients were included in
the study. Factors related to overall infection were: higher risk adjustment
for congenital heart surgery, age > 1-year-old, cyanotic cardiac anomaly,
parenteral or mixed nutrition support, more than 5 days of fasting, and
mechanical ventilation ⩾ 48 . Factors related to pneumonia were higher risk
adjustment for congenital heart surgery, cyanotic cardiac anomaly more than
three inotropics infused during surgery, parenteral or mixed nutritional
support, more than 5 days of fasting, and mechanical ventilation ⩾ 48 h.
Factors related to mediastinitis and sepsis were: age > 1-year-old, aortic
clamp ⩾ 120 min, parenteral or mixed nutritional support, more than 5 days
of fasting, and mechanical ventilation ⩾ 48 h. In the multivariate survival
analysis, parenteral or mixed nutrition and mechanical ventilation ⩾ 48 h
increased the risk for overall infection (relative risk 1.949, 95% confidence
interval 1.108–3.43, P=0.021 and relative risk 25, 95% confidence
interval 2.53–246.19, P =0.006 respectively). Early enteral nutrition
after surgery and early weaning from mechanical ventilation (less than 48 h)
will reduce infection incidence.
Keywords: Congenital heart disease, surgery, pediatric intensive care unit, nutrition support, infection
