Aim Although prolonged mechanical ventilation after cardiac surgery in paediatric patients has been shown to be associated with increased morbidity and mortality, the number of studies involving neonatal cases is limited. In this study we aimed to determine the risk factors for prolonged mechanical ventilation in newborns operated on due to congenital heart disease.

Material and Method This retrospective cohort study was conducted between April 2018 and December 2020 in a single center on neonates operated on due to congenital heart disease in the first 28 days of life. Patients who underwent off-pump surgeries were excluded from the study. Prolonged mechanical ventilation (PMV) was defined as >72 hours of ventilation. Preoperative clinical characteristics, underlying cardiovascular diagnosis, RACHS-1 score and need for preoperative mechanical ventilation were obtained from medical records. Perioperative data and postoperative inotrope scores, postoperative morbidities and 30-day mortality were also recorded. After univariate analysis, a stepwise logistic regression analysis was used to evaluate the independent risk factors for PMV following cardiac surgery.

Results A total of 115 patients were included in the study. In the postoperative period, 45 (39.1%) patients were intubated for >72 hours. In the PMV group, the postnatal operation day was earlier, the RACHS-1 score, the frequency of single ventricle pathology and the need for preoperative mechanical ventilation were significantly higher. Furthermore postoperatively, the maximum vasoactive inotrope scores (VIS) in the first two days and the incidence of acute kidney injury (AKI), fluid overload, sepsis and the pulmonary complications were higher. Preoperative mechanical ventilation (OR: 2.90 (1.17–7.16), p=0.018) and postoperative AKI (OR: 6 (2.60–13.84), p=0.01) were independent risk factors for PMV.

Conclusions This study demonstrates that the frequency of PMV after cardiac surgery is higher in neonatal patients. Preoperative mechanical ventilation and postoperative AKI are risk factors for PMV after neonatal cardiac surgery.