Objectives: We aimed to validate the vasoactive-ventilation-renal (VVR) score and to compare it with other indices as a predictor of outcome in neonates recovering from surgery for critical congenital heart disease. We also sought to determine the optimal time at which the VVR score should be measured. Methods: We retrospectively reviewed neonates recovering from cardiac surgery between July 2017 and June 2020. The VVR score was calculated at admission, 24, 48, and 72 hours postoperatively. Max values, defined as the highest of the four scores, were also recorded. The main end result of interest was a composite outcome which included prolonged intensive care unit stay and mortality. Receiver operating characteristic curves were generated, and areas under the curve with 95% confidence intervals were calculated for all time points. Multivariable logistic regression modeling was also performed. Results: We reviewed 73 neonates and 21 of them showed composite outcomes. The area under the curve value for VVR score as a predictor of composite outcome was greatest at postoperative 72-hour max (AUC= 0.967; 95% confidence interval, (0.927-1). On multivariable regression analysis, the VVR max 72 hours remained a strong independent predictor of prolonged ICU stay and mortality (odds ratio, 1.452; 95% confidence interval, 1.036-2.035). Conclusions: We validated the utility of the VVR score in neonatal cardiac surgery for critical congenital heart disease. The VVR follow-up in postoperative 72 hours is superior to other indices and especially the maximum VVR value is a potentially powerful clinical tool to predict ICU stay and mortality.

Objective: The aim of our study is to determine the relationship between exposure to hemodynamically significant patent ductus arteriosus and morbidities in premature babies, the optimal number of pharmacologic treatment cycles, and ideal ductus ligation timing. Materials and Methods: The study was a retrospective single-center study conducted in a 3-year period between July 2017 and June 2020. Premature babies, born ≤30 weeks of gestation and transferred to our unit for bedside ductus ligation, were included in the study. The subjects were divided into 2 groups; Group A consisted of the patients who received ≥3 pharmacologic treatment cycles, and group B consisted of the patients who received ≤2 cycles. The groups were compared according to preoperative and postoperative features. The main outcome of the study was the presence of severe bronchopulmonary dysplasia. The secondary outcomes were specified as the length of stay in the neonatal intensive care unit and the duration of invasive mechanical ventilation (MV). Results: The study group consisted of 24 patients. There were 10 patients in group A and 14 patients in group B. The mean gestational week and the mean birthweight were found to be 26,7 ± 2.2 weeks and 928 ± 190 g, respectively. The incidence of severe bronchopulmonary dysplasia was significantly higher in group A (70% vs. 14.3%; P = .019). Post-ligation invasive MV, duration, and length of stay in the intensive care unit were found to be significantly longer in group A. None of the patients had hemodynamic disturbances or complications during and after the operation. Conclusions: Bedside surgical ductus ligation is a safe procedure. Prolonging pharmacologic treatment in order to avoid surgery increases the risk of severe bronchopulmonary dysplasia and prolongs hospital stay. Cite this article as: Zubarioglu AU, Yildirim O, Zeybek C, et al. The ideal timing of bedside surgical ligation of patent ductus arteriosus in premature babies less than 30 gestational weeks. Turk Arch Pediatr. 2021; 56(4): 300-307.

Background: Oculo-auriculo-vertebral spectrum is a heterogeneous group of genetic disorder, also known as Goldenhar Syndrome, which has several phenotypic features including craniofacial anomalies, cardiac, vertebral and central nervous system defects. Cardiovascular anomalies include ventricular septal defects, atrial septal defects, patent ductus arteriosus, Tetralogy of Fallot, double outlet right ventricle, aberrant right subclavian artery, coarctation of aorta, transposition of the great arteries, double inlet left ventricle, cor triatriatum, pulmonary artery stenosis, aortic stenosis, persistent left superior vena cava, partially or totally abnormal pulmonary venous return and bicuspid aortic valve. Persistent fifth aortic arch, also named as double lumen aortic arch, is a very rare cardivascular anomaly and usually associate other cardiac defects.Case presentation: We present a 7 month old patient with oculo-auriculo-vertebral spectrum signs as facial asymmetry, short neck, choanal atresia, cleft palate, bilateral preauricular skin tags, bilateral hypoplastic ear lobes, epibulbar dermoid cyst, rib, vertebrae and cardiovascular anomalies. Cardiovascular anomalies detected with echocardiography and computed tomography were malalignment ventricular septal defect and double lumen aorta, known as persistent fifth aortic arch.Conclusion: Various cardiovascular anomalies may accompany Goldenhar Syndrome. We present a case with persistent fifth aortic arch and Oculo-auriculo-vertebral spectrum and this is a new association that was not reported before in the literature.

Background: This study evaluated the indications, airway findings, therapeutic interventions, and clinical outcomes associated with bronchoscopy in pediatric cardiac surgery patients, including the selective role of rigid bronchoscopy. Methods: This retrospective, single-center study included patients who underwent bronchoscopy between January 2019 and January 2025. Among 1840 surgical patients, 60 required bronchoscopy because of prolonged mechanical ventilation, extubation failure, difficulty weaning from ventilatory support, or suspected airway pathology. Results: The median age of the patients was 9 months, and the first bronchoscopy was performed at a median of 8.5 postoperative days (range, 5-24 days). Findings were normal in 32/60 patients (53.3%). The most common abnormalities were mucus plugging/secretion retention (20.0%, 12/60), blood clots (8.3%, 5/60), and tracheomalacia (8.3%, 5/60). Thirteen patients underwent 16 rigid bronchoscopic procedures. Bronchoscopy guided subsequent management, including diaphragmatic plication in four patients and surgery for bronchial compression in three. Among 17 patients with mucus plugging/secretion retention or blood clot, eight achieved successful extubation without tracheostomy. Tracheostomy was performed in 34/60 patients (56.7%), and in-hospital mortality in this group was 28.3% (17/60). Brief transient oxygen desaturation occurred occasionally, but no major procedure-related complications were observed. Conclusions: Bronchoscopy provides clinically useful diagnostic and therapeutic information in selected pediatric cardiac surgery patients. Mucus plugging or retained secretions were the most common abnormal finding, while normal findings helped redirect evaluation toward alternative causes of ventilator dependence. Flexible bronchoscopy was adequate for most patients, whereas rigid bronchoscopy was reserved for selected cases of dense mucus plugs or organized blood clots that could not be adequately removed with flexible techniques.

Background: Tracheostomy is infrequently required after paediatric cardiac surgery and is generally considered for patients with prolonged mechanical ventilation or recurrent extubation failure. This study aimed to identify factors associated with the need for tracheostomy and to evaluate clinical outcomes among these patients. Methods: We retrospectively reviewed 1,840 paediatric patients who underwent cardiac surgery at a single centre between 2019 and 2025. Demographic, perioperative, and postoperative factors associated with the need for tracheostomy, as well as outcomes among patients who underwent tracheostomy, were evaluated. Results: Tracheostomy was performed in 34 patients (1.8%). The median age was 8 months, and 22 patients (64.7%) were younger than 1 year. Tracheostomy was performed at a median of 28.5 days after surgery, and the median total duration of mechanical ventilation during hospitalisation was 65 days. Age < 1 year was independently associated with the need for tracheostomy (odds ratio, 2.59; 95% confidence interval, 1.26–5.35; p = 0.010). Haemofiltration was also associated with tracheostomy (odds ratio, 3.94; 95% confidence interval, 1.84–8.44; p < 0.001), likely reflecting greater postoperative disease severity. Overall mortality was 20.6% (7/34), with no deaths related to tracheostomy. Among the 27 survivors, 24 (88.9%) underwent decannulation at a median of 62 days after tracheostomy. Two survivors were discharged with home mechanical ventilation, and one was discharged with a tracheostomy in place. Conclusions: Tracheostomy was uncommon after paediatric cardiac surgery and was primarily used in patients with prolonged and complex postoperative recovery. The need for tracheostomy appeared to reflect both patient‑related factors and greater postoperative complexity.