Neonatal Chylothorax and Early Fluid Overload After Cardiac Surgery: Retrospective Analysis of the Neonatal and Pediatric Heart and Renal Outcomes Network Registry (2015-2018)

Diagnostic Accuracy Prior to Congenital Heart Defect Surgery: A Multicenter Collaboration

BACKGROUND

Echocardiography is the mainstay for diagnosing congenital heart disease (CHD). Diagnostic errors can lead to suboptimal surgical outcomes.

OBJECTIVES

This multicenter pediatric echocardiography collaborative learning initiative explores reasons for diagnostic errors, investigates associations between patient- and center-specific factors and errors, and relays the benefits of a multicenter approach to decrease these errors as a first step to improve CHD surgical outcomes.

METHODS

Participating centers submitted diagnostic evaluations on patients prior to 2-ventricle repair into a central database. We held virtual meetings to revise variables and discuss cases to learn from each other.

RESULTS

Fourteen pediatric echocardiography laboratories entered data on 1,476 consecutive patients with specific cardiac diagnoses who underwent a two-ventricle repair over 11 months. The mean error rate across centers was 7.1% (103 errors, 17/126-6/125). Seventy-six (74%) errors were preventable or possibly preventable. Cognitive (43%) and imaging factors (47%) commonly contributed to these errors. Moderate to severe impact on postoperative outcomes occurred in 19 (25%) preventable or possibly preventable errors. There were no statistically significant associations between patient- or center-specific factors and errors.

CONCLUSIONS

This work represents the feasibility and advantages of a multicenter approach to preoperative diagnostic errors. Variability existed in sedated protocols, number of echos needed, use of other modalities, and in other processes. Common anatomic areas were found. Rather than undertaking isolated, single-center projects, this collaborative is poised to learn about novel changes that would improve diagnostic accuracy across centers as a first step to advancing surgical outcomes for patients with CHD.

Nutritional, Metabolic, and Inflammatory Alterations in Children with Chylous Effusion in the Postoperative Period of Cardiac Surgery: A Descriptive Cohort

OBJECTIVE

The occurrence of chylous effusion in children undergoing cardiac surgery is progressively increasing due to technical advances that have led to a rise in the number of surgeries. In this context, the objective was to describe the clinical profile of a cohort of patients at the time of chylous effusion diagnosis.

METHODS

A retrospective cohort analysis was conducted between January 2011 and July 2023, involving 23 patients, aged 0 to 18 years, treated at a quaternary university hospital in southeastern Brazil. Data were obtained from the follow-up records of the Multidisciplinary Nutritional Therapy Team (MNTT) for patients who received nutritional support after developing chylous effusion in the postoperative period of cardiac surgery.

RESULTS

The younger population predominated (median age of 6 months), with a high prevalence of malnutrition (60.9%). At the time of chylous effusion diagnosis, 83% had lymphopenia, and 74% had hypoalbuminemia. The longer the time elapsed after surgery for the onset of chylous effusion, the lower the HDL cholesterol, the lower the albumin levels, the greater the surgical complexity, the younger the patient, and the lower their weight. Hypocalcemia occurred in nearly half of the sample and hypophosphatemia in 26% of the analyzed cases.

CONCLUSIONS

There was a notable presence of lymphopenia, hypoalbuminemia, and low HDL cholesterol, as well as a high incidence of mineral imbalances, particularly hypocalcemia and hypophosphatemia, which, if untreated, may lead to unfavorable outcomes. Therefore, clinical and laboratory monitoring of children in the postoperative period of cardiac surgery is important and can aid in the early diagnosis of chylous effusion and, consequently, in the timely initiation of treatment.