Pediatr Crit Care Med. 2026 Feb 18. doi: 10.1097/PCC.0000000000003918. Online ahead of print.
ABSTRACT
OBJECTIVE: The use of post-extubation respiratory support in single-ventricle neonates undergoing the Norwood procedure is poorly described. We investigated the patterns of respiratory support following extubation as well as factors associated with prolonged exposure to post-extubation noninvasive respiratory support (NRS), defined as greater than or equal to 72 hours, in neonates recovering from the Norwood procedure.
DESIGN: Two-center retrospective cohort study.
SETTING: North American pediatric cardiac ICUs.
PATIENTS: Neonates (< 1 mo at the time of surgery) undergoing a Norwood procedure between January 1, 2019, and December 31, 2023.
MEASUREMENTS AND MAIN RESULTS: The study included 127 neonates of whom 60 (47%) experienced the primary outcome of prolonged NRS. In multivariable analysis, the presence of an airway anomaly (adjusted odds ratio [aOR] 3.6; 95% CI, 1.4-8.9; p = 0.006), an unplanned surgical or catheter-based reintervention (aOR 3.2; 95% CI, 1.3-7.5; p = 0.010), and longer postoperative mechanical ventilation (aOR 1.1; 95% CI, 1.0-1.2; p = 0.018) were independently associated with prolonged NRS. Patients with prolonged NRS had lower weight-for-age z score at cardiac ICU (CICU) discharge (-2.11 vs. -1.14; p = 0.004), longer CICU length of stay (25.1 vs. 11.1 d; p < 0.001), and longer postoperative sedative exposure (59.8 vs. 16.8 d; p < 0.001).
CONCLUSIONS: Prolonged NRS is common in neonates following the Norwood procedure. Patients receiving prolonged NRS experience worse clinical outcomes.
PMID:41705886 | DOI:10.1097/PCC.0000000000003918
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