Advisory Committee Chair
Gerald McGwin
Advisory Committee Members
Suzanne Perumean-Chaney
Stella Aslibekyan
Document Type
Thesis
Date of Award
2022
Degree Name by School
Master of Science (MS) School of Public Health
Abstract
Prophylactic peritoneal dialysis (PD) in neonates undergoing cardiac surgery with cardiopulmonary bypass (CPB) has proven to be safe and improve outcomes. Understanding which neonates would most benefit from prophylactic PD is needed to optimize care. Objective: We sought to validate patient-specific characteristics associated with the need for PD in neonates requiring CPB. We hypothesized serum creatinine (SCr), pre-operative weight, or open chest post-operatively are associated with the need for PD. Methods: We evaluated neonates in the cardiac ICU requiring cardiac surgery with CPB from March 2019 through March 2021 with our new protocol for PD catheter placement. Neonates were classified as those who “needed PD” and those who “did not need PD.” Those who “needed PD” had a PD catheter placed in the OR that was used for >48 hours, or those who did not have a PD catheter placed in the OR, but in retrospect would have benefited from PD based on predetermined clinical findings. Those who “did not need PD” did not have a PD catheter placed and would not have benefitted from PD, or if placed it was removed or put to drain ≤ 48 hours post-operatively. Results: Of the 97 neonates, 29% were categorized as “needed PD” and 71% as “did not need PD.” Neonates with higher STAT scores were associated with needing PD (Median = 5 [4-5] versus 4 [3-4.25], p<0.0001, 95% CI (0.52 to 1.09)). Neonates with an open chest post-operatively were more likely to need PD (p<0.0001). After adjusting for STAT iv score, neonates with an open chest post-operatively were 14 times more likely to need PD (AOR=14.00; p=0.0038, 95% CI (1.53 to 127.89). After adjusting for open chest, for every 1 unit increase in STAT score there was a 2.54 higher odds for needing PD (AOR=2.54; p=0.0461, 95% CI (0.94 to 6.88)). Conclusion: Implementation of our risk-based assessment has improved our ability to provide prophylactic PD to neonates requiring CPB. In contrast to our retrospective analysis, only having an open chest post-operatively was associated with needing PD in our prospective analysis. Additional larger prospective studies are needed to further validate our findings.
Recommended Citation
Webb, Tennille N., "Early Detection of Acute Kidney Injury in Neonates After Cardiopulmonary Bypass" (2022). All ETDs from UAB. 142.
https://digitalcommons.library.uab.edu/etd-collection/142