Content area
Abstract
Objective: Investigate a 12-hour delayed rewarming intervention on serum biomarkers of brain injury and frequency of severe adverse events (SAE) in infants following congenital heart disease (CHD) surgery.
Design: Pilot study
Setting: Tertiary care center in the northeastern United States
Patients: Infants with CHD < 6 months old randomized to the delayed rewarming intervention or to standard of care.
Intervention: Delayed rewarming using a commercially available device to gradually increase core temperature over 12 hours from 35°C to 36.5°C.
Main Results: Sixteen infants were randomized to standard care and 22 to the intervention. Ten (26%) infants had a diagnosis of Trisomy 21 and 12 (32%) had surgery in the first two weeks of life. Serum biomarker analysis could not be performed due to poor specimen quality and excessive missingness. Four (25%) infants in the standard of care group had one or more SAEs following surgery including death, need for extra-corporeal membranous oxygenation, return to operating room or need for cardiopulmonary resuscitation compared to three (14%) infants in the intervention group (p=0.43). In the intervention group, infant temperature gradually increased to 36.5°C as planned 12 hours following surgery. Heart rates for infants in the intervention group were 20 beats per minute lower at the start of the intervention, remained slower during the intervention and for the 36-hours after the intervention without associated differences in systolic or diastolic blood pressures. Intervention infants also had lower chest tube output, shorter mean duration of intubation (3.9 vs 2.8 days, p=0.4) and decreased pediatric intensive care unit length of stay (8.1 vs 9.6 days, p=0.49).
Conclusions: In this small sample, there were no differences in biomarkers or SAEs, however the infants in the intervention group appeared to be more hemodynamically stable with lower heart rates, decreased chest tube output and fewer days of intubation.
