Faculty Collaboration Database

Conjugated hyperbilirubinemia is associated with increased morbidity and mortality after neonatal heart surgery. Cardiol Young 2024 May;34(5):1083-1090

Date

12/18/2023

Pubmed ID

38105562

DOI

10.1017/S1047951123004158

Scopus ID

2-s2.0-85180351140 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

BACKGROUND: Cholestasis characterised by conjugated hyperbilirubinemia is a marker of hepatobiliary dysfunction following neonatal cardiac surgery. We aimed to characterise the incidence of conjugated hyperbilirubinemia following neonatal heart surgery and examine the effect of conjugated hyperbilirubinemia on post-operative morbidity and mortality.

METHODS: This was a retrospective study of all neonates who underwent surgery for congenital heart disease (CHD) at our institution between 1/1/2010 and 12/31/2020. Patient- and surgery-specific data were abstracted from local registry data and review of the medical record. Conjugated hyperbilirubinemia was defined as perioperative maximum conjugated bilirubin level > 1 mg/dL. The primary outcome was in-hospital mortality. Survival analysis was conducted using the Kaplan-Meier survival function.

RESULTS: Conjugated hyperbilirubinemia occurred in 8.5% of patients during the study period. Neonates with conjugated hyperbilirubinemia were more likely to be of younger gestational age, lower birth weight, and non-Caucasian race (all p < 0.001). Patients with conjugated hyperbilirubinemia were more likely to have chromosomal and non-cardiac anomalies and require ECMO pre-operatively. In-hospital mortality among patients with conjugated hyperbilirubinemia was increased compared to those without (odds ratio 5.4). Post-operative complications including mechanical circulatory support, reoperation, prolonged ventilator dependence, and multi-system organ failure were more common with conjugated hyperbilirubinemia (all p < 0.04). Patients with higher levels of conjugated bilirubin had worst intermediate-term survival, with patients in the highest conjugated bilirubin group (>10 mg/dL) having a 1-year survival of only 6%.

CONCLUSIONS: Conjugated hyperbilirubinemia is associated with post-operative complications and worse survival following neonatal heart surgery. Cholestasis is more common in patients with chromosomal abnormalities and non-cardiac anomalies, but the underlying mechanisms have not been delineated.

Author List

Hunt M, de Jong IEM, Wells RG, Shah AA, Russo P, Mahle M, Gardner MM, Fuller S, Chen J, Gaynor JW

Author

Mallory Hunt MD Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Bilirubin
Cardiac Surgical Procedures
Female
Gestational Age
Heart Defects, Congenital
Hospital Mortality
Humans
Hyperbilirubinemia
Incidence
Infant, Newborn
Male
Morbidity
Postoperative Complications
Retrospective Studies
Risk Factors