title: Increased calcium supplementation is associated with morbidity and mortality in the infant postoperative cardiac patient.
abstract: OBJECTIVE
  The purpose of this study was to assess the association of calcium replacement therapy with morbidity and mortality in infants after cardiac surgery involving cardiopulmonary bypass.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  The cardiac intensive care unit at a tertiary care children's hospital.
  
  
  METHODS
  Infants undergoing cardiac surgery involving cardiopulmonary bypass between October 2002 and August 2004.
  
  
  METHODS
  None.
  
  
  RESULTS
  Total calcium replacement (mg/kg calcium chloride given) for the first 72 postoperative hours was measured. Morbidity and mortality data were collected. The total volume of blood products given during the first 72 hrs was recorded. Infants with confirmed chromosomal deletions at the 22q11 locus were noted. Correlation and logistic regression analyses were used to generate odds ratios and 95% confidence intervals, with p < .05 being significant. One hundred seventy-one infants met inclusion criteria. Age was 4 +/- 3 months and weight was 4.9 +/- 1.7 kg at surgery. Six infants had deletions of chromosome 22q11. Infants who weighed less required more calcium replacement (r = -.28, p < .001). Greater calcium replacement correlated with a longer intensive care unit length of stay (r = .27, p < .001) and a longer total hospital length of stay (r = .23, p = .002). Greater calcium replacement was significantly associated with morbidity (liver dysfunction [odds ratio, 3.9; confidence interval, 2.1-7.3; p < .001], central nervous system complication [odds ratio, 1.8; confidence interval, 1.1-3.0; p = .02], infection [odds ratio, 1.5; confidence interval, 1.0-2.2; p < .04], extracorporeal membrane oxygenation [odds ratio, 5.0; confidence interval, 2.3-10.6; p < .001]) and mortality (odds ratio, 5.8; confidence interval, 5.8-5.9; p < .001). Greater calcium replacement was not associated with renal insufficiency (odds ratio, 1.5; confidence interval, 0.9-2.3; p = .07). Infants with >1 sd above the mean of total calcium replacement received on average fewer blood products than the total study population.
  
  
  CONCLUSIONS
  Greater calcium replacement is associated with increasing morbidity and mortality. Further investigation of the etiology and therapy of hypocalcemia in this population is warranted.
authors.affiliation: Department of Pediatrics, The Ohio State Unviersity, and Columbus Children's Hospital, The Heart Center, Columbus, OH 43205-2696, USA. lpdyke@gmail.com
authors.forename: Peter C
authors.initials: PC
authors.lastname: Dyke
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Yates
authors.forename: Clifford L
authors.initials: CL
authors.lastname: Cua
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Hoffman
authors.forename: John
authors.initials: J
authors.lastname: Hayes
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Feltes
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Springer
authors.forename: Roozbeh
authors.initials: R
authors.lastname: Taeed
mesh_terms: D002118:Calcium; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D019587:Dietary Supplements / Q000009:adverse effects*; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011184:Postoperative Period; D012189:Retrospective Studies
chemical_list: D002118:Calcium