Evaluation of complications of postoperative respiratory system in newborn cases operated during congenital heart disease

Despite advances in surgical technique and monitorization, postoperative complications in newborns undergoing cardiac surgery are important cause of morbidity and mortality even in developed countries. Respiratory complications some of which are preventable are among the most significant ones and may adversely affect the outcome. We aimed to investigate the incidence of respiratory complications in newborns after cardiac surgery, risk factors for occurence and effect on morbidity and mortality retrospectively. A total of 198 patients under 1 month of age who underwent cardiac surgery at Cardiovascular Surgery Department between January 2011 and January 2016 were studied retrospectively. Gender, birth weight, weight at the time of operation, height, cardiac diagnosis, incision type, surgery, operation time , aortic clamp time, cardiopulmonary bypass time, duration of stay in intensive care unit, mechanical ventilation, requirement of reintubation, postoperative complications of the respiratory system, other complications in the intensive care unit, mortality and presence of arrhythmia were recorded. Operation notes, intensive care unit data, detailed reports of the patients were examined from the information bank of Nucleus hospital information systems. Effect of respiratory complications on morbidity and mortality is investigated. Statistical significance level was accepted as p <0.05. Postoperative respiratory complications developed in 46.5% of the patients of which 131 (66.2%) were male and 67 (33.8%) were female. Diaphragmatic paralysis occurred in 29.3% of 92 patients with respiratory system complication, prolonged pleural effusion in 25%, pneumothorax in 14.1% and atelectasis in 12 %, lung infection in 6.5%, vocal cord paralysis in 3.3%, chylothorax in 3.3%, subglottic stenosis in 3.3%, subglottic stenosis with vocal cord paralysis in 1.1%, subglottic stenosis with pneumothorax in 1.1% and finally subglottic stenosis with diaphragmatic paralysis in 1.1%. We found that diapragmatic paralysis was the most common respiratory complication (29.3%). The duration of mechanical ventilation, duration of stay in intensive care unit, duration of stay in hospital were all longer in patients with respiratory complications than those without. In conclusion, the presence of respiratory system complications such as subglottic stenosis, diaphragmatic paralysis, prolonged pleural effusion, pneumothorax, pulmonary infection causes prolonged stay in intensive care unit and increases risk of reintubation in neonates who underwent cardiac surgery.