In this study, we aimed to evaluate the factors affecting major adverse event (MAE) development after full-term neonatal cardiac surgery. This study was conducted retrospectively on newborns who underwent congenital heart surgery between June 1, 2020, and June 1, 2022. MAE was defined as the presence of at least one of the following: cardiac arrest, unplanned reoperation, emergency chest opening, admission to the advanced life support system, and death. The role of blood lactate level, vasoactive inotropic score (VIS), and cerebral near-infrared spectroscopy (NIRS) changes in predicting MAE was investigated. A total of 240 patients (50% male) were operated during the study period. The median age of patients was seven days (interquartile range 3-10 days). MAE was detected in 19.5% of the cases. Peak blood lactate levels >7 mmol/liter (area under the curve [AUC] 0.72, 95% confidence interval [CI] [0.62-0.82], P<0.001, sensitivity 76%, specificity 82%, positive predictive value [PPV] 88%) was an independent risk factor for MAE (odds ratio [OR] 2.7 [95% CI 1.3-6]). More than 30% change in NIRS value during the operative period (AUC 0.84, 95% CI [0.80-0.88], P 10 was an independent risk factor (AUC 0.75, 95% CI [0.70-0.84], P 30%, high blood lactate levels, and VIS score within the 48 hours may help to predict the development of MAE in the postoperative period.

Objective The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak had an enormous global impact. Pregnant women with SARS-CoV-2 appear to have higher morbidity and mortality. This study aimed to evaluate the effect of the severity of maternal SARS-CoV-2 infection on neonatal outcomes. Study Design The clinical and laboratory data of 40 women and neonates evaluated retrospectively. Results This retrospective study showed that SARS-CoV-2 infection had an adverse impact on neonatal outcomes proportionally with the maternal disease severity including increased prematurity rates, postnatal resuscitation need, prolonged hospital stay and longer ventilatory support requirement in infants born to mothers with moderate or severe disease. Conclusion Maternal disease severity had adverse effects on neonatal outcomes. The severity of maternal disease was found to be associated with increased rates of prematurity, requirement of postnatal resuscitation, prolonged hospital stay, and longer ventilatory support. Key Points

Introduction: Transposition of great arteries is one of newborns' most common cyanotic CHDs, and its treatment is arterial switch operation in the first days of life. Low cardiac output syndrome may develop in the early postoperative period. In this study, we evaluated perfusion index and left ventricular output blood flow changes in patients who underwent arterial switch operation and developed low cardiac output syndrome.Methods: This study was conducted prospectively in newborns with transposition of great arteries who underwent arterial switch operation between 1st August 2020 and 1st August 2022. Low cardiac output syndrome score and left ventricular output were investigated. Initially, 6^th, 12^th, 18^th, and 24^th hour perfusion index and left ventricular output values of patients with and without low cardiac output syndrome were recorded. The results were evaluated statistically.Results: A total of 60 patients were included in the study. Sex distribution was equal. The median age at the time of surgery was 5 days (interquartile range 3–7 days), and the median weight was 3.1 kg (interquartile range 2.9–3. 4). Low cardiac output syndrome was detected in 30% (n = 18) of cases. The median perfusion index of patients who developed low cardiac output syndrome was significantly lower at the 12^th, 18^th, and 24^th hours (p < 0.05) (0.99 versus 1.25, 0.86 versus 1.21, and 0.96 versus 1.33, respectively). Similarly, the median left ventricular output of patients who developed low cardiac output syndrome was significantly lower at 12^th, 18^th, and 24^th hours (p < 0.05) (95 versus 110 ml/kg/min, 89 versus 109 ml/kg/min, and 92 versus 112 ml/kg/min, respectively). There was a significant correlation between perfusion index values and left ventricular output at all measurements (r > 0.500, p < 0.05).Conclusion: Perfusion index and left ventricular output measurements decreased in newborns who developed low cardiac output syndrome after arterial switch operation, especially at 12^th and 18^th hours. Serial perfusion index and left ventricular output measurements can be instructive in predicting low cardiac output syndrome development.

Introduction: Total abnormal pulmonary venous return anomaly (TAPVD) is a congenital heart disease characterized by abnormal pulmonary venous drainage to the right atrium. The Neutrophil/Lymphocyte Ratio (NLR) is used to predict mortality and morbidity after congenital heart surgery. In this study, the effect of postoperative NLR changes on prolonged intensive care unit stay in newborns with TAPVD was searched. Patients and Methods: The newborns with TAPVD who were followed up and operated on in the pediatric cardiac intensive care unit between May 1, 2020, and May 1, 2022, were included in the study. Hematological parameters and NLR changes were recorded before and after the operation (1 st-2 nd-3 rd days). Long ICU duration (PCILOS, being in the longest 25 percent as duration) was accepted as morbidity. The effects of NLO changes on PCILOS were examined. Results: Twenty-four patients were included in the study. The median age was 18 days (IQR 12 days-24 days) and the median weight was 3 kg (IQR= 2.8-3.2). Fifteen patients were male (63%). Median mechanical ventilator duration, intensive care unit stay, and hospital stay were 40 hours (IQR= 30-48 hours), seven days (IQR= 5-9), and 15 days (IQR= 12-18), respectively. PCILOS duration was determined as >9 days. Three patients (12.5%) died in the postoperative first 30 days. Preoperative NLR value> 1.9 and postoperative 3rd day NLR> 2.8 predicted PCILOS strongly. Conclusion: High NLR values in the preoperative and early postoperative periods of neonates with total abnormal pulmonary venous return anomaly may be helpful to predict prolonged ICU stay.

Amaç: Konjenital kalp hastalıkları yenidoğanın en sık yoğun bakımda yatış nedenlerinden biridir. Nozokomiyal enfeksiyonlar bu olgularda artmış mortalite ve morbiditeye neden olabilmektedir. Bu çalışmada, yenidoğan konjenital kalp cerrahisi yapılan olgularda nozokomiyal enfeksiyonların sıklığını ve gelişimini etkileyen risk faktörlerinin araştırılması amaçlandı. Gereç ve Yöntemler: Bu çalışma, 1 Kasım 2021–1 Kasım 2022 tarihleri arasında pediatrik kardiyak yoğun bakımda izlendi ve kalp cerrahisi operasyonu yapılan yenidoğanlarda retrospektif olarak gerçekleştirildi. Nozokomiyal enfeksiyon gelişen ve gelişmeyen olgular perinatal öykü, doğum ağırlığı, sendrom varlığı, koroner kalp hastalığının kompleksite derecesi, perioperatif ve postoperatif faktörler, kateter varlığı ve süresi, mekanik ventilatör vb. durumlar açısından değerlendirildi. Sonuçlar istatistiksel olarak incelendi. Bulgular: Bu dönemde, 140 olguya yenidoğan kalp cerrahisi operasyonu yapıldı. Kırk (%28) olguda 54 farklı nozokomiyal enfeksiyon saptandı. En sık %60 olarak kan akımı enfeksiyonu gözlenirken, bunu %25 olguda alt solunum yolu enfeksiyonu ve %15 olguda yara yeri enfeksiyonu takip etmekteydi. Saptanan enfeksiyon ajanlarının %55’ini gram-negatif mikroorganizmalar, %30’unu gram-pozitif mikroorganizmalar ve %15’ini fungal mikroorganizmalar oluşturmaktaydı. Nozokomiyal enfeksiyon ile ilişkili bağımsız risk faktörleri; sendrom varlığı (Odds Ratio [OR] 6,1, %95 Güven Aralığı [GA] 1,3–18), santral venöz kateter süresi >10 gün (OR 3,7, %95 GA 1,3–11,0), mekanik ventilasyon süresi >7 gün (OR 6,6, %95 GA 2,1–20,1) ve operasyon sonrası >6 kan ürünü transfüzyonu (OR 3,1, %95 GA 1,3–8,5) olarak saptandı. Nozokomiyal enfeksiyona bağlı ölüm %25 olarak tespit edildi. Tartışma: Nozokomiyal enfeksiyonlar konjenital kalp cerrahisi geçiren yenidoğanlarda önemli mortalite ve morbidite nedenidir. Özellikle kan dolaşımı ve alt solunum yolu enfeksiyonlarının önlenmesine çaba gösterilmelidir. Objective: Congenital heart diseases (CHD) are one of the most common causes of neonatal intensive care hospitalization. Nosocomial infections may cause increased mortality and morbidity in these cases. In this study, it was aimed to investigate the frequency and risk factors affecting the development of nosocomial infections in patients who underwent neonatal congenital heart surgery. Material and Methods: This study was carried out retrospectively in newborns who were followed up in the pediatric cardiac intensive care unit and underwent cardiac surgery between November 1, 2021 and November 1, 2022. Cases with and without nosocomial infection were evaluated in terms of perinatal history, birth weight, presence of syndrome, degree of complexity of CHD, perioperative and postoperative factors, presence and duration of central venous catheter, mechanical ventilator, etc. The results were analyzed statistically. Results: During the study, neonatal cardiac surgery was performed in 140 cases. 54 different nosocomial infections were detected in 40 (28%) cases. Bloodstream infection was the most common in 60%, followed by lower respiratory tract infection in 25% and wound infection in 15%. Of the detected infectious agents, 55% were gram (-) organisms, 30% were gram (+) organisms, and 15% were fun-gal organisms. The presence of independent risk factors associated with nosocomial infection was congenital syndromes (OR 6.1, CI 95% 1.3–18), central venous catheter time >10 days (OR 3.7, CI 95% 1.3–11.0), mechanical ventilation time >7 days (OR 6.6, CI 95% 2.1–20.1), and post-operative >6 blood product transfusions (OR 3.1, CI 95% 1.3–8.5). Mortality due to nosocomial infection was 25%. Conclusion: Nosocomial infections are an important cause of mortality and morbidity in newborns undergoing congenital heart surgery. In particular, efforts should be made to prevent neonates from bloodstream and lower respiratory tract infections.

Objectives: In the neonatal period, 25% of cases with critical congenital heart disease (CCHD) require surgical or interventional palliative and corrective procedures. Prenatal diagnosis and timely intervention can positively impact neonatal mortality and morbidity. This study evaluated the effects of perinatal follow-up on the management of CCHD. Methods: The study was conducted on term neonates diagnosed with CCHD, who were monitored in the neonatology and pediatric cardiac intensive care unit between 1 January 2023 and 1 January 2024. The cases were categorized into CCHD with prenatal follow-up (Group I), CCHD born without follow-up at our hospital (Group II), and CCHD accepted from external centers (Group III). Neonatal mortality and morbidity outcomes of these cases that underwent surgical or interventional procedures were statistically evaluated. Results: During the study period, there were 280 neonatal cases (50% male). Among these cases, 30% were in Group I (n = 84), 20% in Group II (n = 56), and 50% in Group III (n = 140). The cesarean section rate was higher in Group I compared to the other groups (80% vs. 52% vs. 45%), and the preoperative lactate levels were lower (0.9 vs. 1.7 vs. 2.1). The anatomical diagnoses, ventricular physiology, operation time, and interventional procedure time were similar. After interventional or surgical procedures, morbidity (22% vs. 25% vs. 36%) and mortality rates (6% vs. 9% vs. 18%) were lower in Group I and Group II compared to Group III. Conclusions: All infants diagnosed with CCHD before birth should be delivered in a tertiary heart center, which positively contributes to neonatal mortality and morbidity. More effort is needed to improve prenatal screening programs.