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GRADE II INTRAVENTRICULAR HEMORRAGE INDEPENDENTLY DOUBLES MORTALITY IN NEONATAL CARDIAC SURGERY
Muhammad Faateh, MBBS, Amir Mehdizadeh-Shrifi, MD, Penelope Dring, BS, Michael A. Carlisle, MD, Colleen Pater, MD, Marco Ricci, MD, MBA, David Lehenbauer, MD, David Morales, MD, Awais Ashfaq, MD.
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Objective: We sought to examine the impact of varying grade of intraventricular hemorrhage(IVH) on neonatal cardiac surgery outcomes.
Methods: Neonates(<30d) undergoing cardiac surgery with the use of cardiopulmonary bypass were identified from the pediatric health information system database. Baseline characteristics and in-hospital outcomes were compared in the following groups: No-IVH, IVH-Grade-I, IVH-Grade-II, and IVH-Grade-III/IV.
Results: A total of 11,898 patients were identified of which 4.8% had IVH, of these the distribution was IVH-I: 50.8%, IVH-II: 31.4%, IVH-III/IVH: 0.7%. Patients in IVH groups were more likely to be pre-term(<37 weeks) (no-IVH: 10.1%, IVH-I: 21.8%, IVH-II: 27.6%, III/IVH: 45.5%), low-birthweight(<2.5 kg)(no-IVH: 10.5%, IVH-I: 21.8%, IVH-II: 27.6%, III/IVH: 37.7%) and had increased utilization of ECMO(no-IVH: 10.2%, IVH-I: 26.7%, IVH-II: 34.3%, III/IVH: 44.2%), all p<0.001. In-hospital mortality was incrementally higher by IVH grade: no-IVH: 7.9%, IVH-I: 16.7%, IVH-II: 29.5%, III/IVH: 38.9%, p<0.001. After adjusting for prematurity, birthweight, ECMO, surgery type among other risk factors, grade-II and III/IV IVH were found to be significant predictors of in-hospital mortality [OR(95%CI), p-value: IVH-I: 1.30(0.89-1.89), p=0.17, IVH-II: 1.98(1.08-3.34), p=0.028, IVH-III/IV: 2.28(1.12-4.65), p=0.023].
Conclusions: Grade-II intraventricular hemorrhages, previously thought to be relatively benign, independently doubles mortality in neonates undergoing cardiac surgery.
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