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VOLUME 4 , ISSUE 1 ( January-March, 2025 ) > List of Articles

REVIEW ARTICLE

Perioperative Care after Surgical Correction of Congenital Heart Defects in Premature Infants

Saif Al-Ethawi, Noor IA-D Sadick, Saif A Hameed, Akram H Salih, Aimen B Ayad, Naif M Alsharari, Roberto M DiDonato, Alvaro Dendi, Mostafa MM Rizk, Georg M Schmölzer, Martin Antelo, Yahya Ethawi

Keywords : Cardiac output, Cardiopulmonary bypass, Colloid, Crystalloid, Multiorgan dysfunction, Neonate, Newborn, Preload, Systemic inflammatory response syndrome, Third space

Citation Information : Al-Ethawi S, Sadick NI, Hameed SA, Salih AH, Ayad AB, Alsharari NM, DiDonato RM, Dendi A, Rizk MM, Schmölzer GM, Antelo M, Ethawi Y. Perioperative Care after Surgical Correction of Congenital Heart Defects in Premature Infants. 2025; 4 (1):25-35.

DOI: 10.5005/jp-journals-11002-0122

License: CC BY-NC 4.0

Published Online: 25-03-2025

Copyright Statement:  Copyright © 2025; The Author(s).


Abstract

The outcomes of premature infants with congenital heart defects following surgical correction can be improved with carefully planned and evidence-based management during the postoperative period. Many pathophysiological changes related to surgery-related tissue disruption and cardiopulmonary bypass include sodium (Na)/water overload, systemic inflammatory response syndrome (SIRS), and ischemia/reperfusion in the heart and other major organs are seen during this period. Focused intensive care is needed with close monitoring of cardiac function, tissue oxygenation, hemostasis, pain control, and sedation. There are also some center-specific needs; all care-providers need to reach a consensus on evidence-based protocols for initiation, maintenance, and weaning from assisted ventilation, which can facilitate earlier extubation and prevent ventilation-related complications. Close monitoring of the cardiac rhythm/function and the hemodynamic status can reduce critical organ dysfunction and SIRS. Measurement of specified laboratory parameters, and imaging such as chest radiography, echocardiography, and structural/functional assessment of other critical organs can help in monitoring these patients for signs of recovery. Monitoring of the sleep−wakefulness cycle, ambient noise and light control, glycemic control, monitoring of electrolytes and other metabolic parameters, feedings, nutrition, and mobilization can promote the quality of recovery. Individualized antibiotic prophylaxis may be needed based on specific defects, type of surgery, severity of illness, prior data, bacterial flora in the center, and assessments by other specialists. Finally, a checklist with clearlydefined management steps for possible needs prior to and after discharge can promote patient safety.

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