title: Risk factors for mediastinitis following median sternotomy in children.
abstract: BACKGROUND
  Mediastinitis is a devastating complication of pediatric cardiothoracic surgery. However, risk factors for the development of mediastinitis are poorly characterized. The objective of this study was to identify risk factors for mediastinitis in a cohort of children undergoing cardiothoracic surgery at a tertiary care children's hospital.
  
  
  METHODS
  This case-control study included patients who underwent median sternotomy between January 1, 1995 and December 31, 2003. Univariate analyses, logistic regression, and multinomial regression were performed to determine the association between potential risk factors and the development of mediastinitis.
  
  
  RESULTS
  Forty-three patients with mediastinitis and 184 patients without mediastinitis were included. One hundred and twelve (49%) patients were female. The median patient age was 128 days (interquartile range: 7 days-2.0 years). A known or possible genetic syndrome was present in 53 (24%) patients. The following factors were associated with the development of mediastinitis: presence of a known or possible genetic syndrome (adjusted odds ratio, OR: 4.5; 95% confidence interval, CI: 1.8-11.4); American Society of Anesthesiologists score >3 (adjusted OR: 3.4; 95% CI: 1.1-10.3); and presence of intracardiac pacing wires for >3 days (adjusted OR: 15.8; 95% CI: 2.0-127.2).
  
  
  CONCLUSIONS
  The presence of a known or possible genetic syndrome, American Society of Anesthesiologists score >3, and the presence of intracardiac pacing wires for >3 days were each associated with the development of mediastinitis in children after median sternotomy.
authors.affiliation: Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Kagen
authors.forename: Ebbing
authors.initials: E
authors.lastname: Lautenbach
authors.forename: Warren B
authors.initials: WB
authors.lastname: Bilker
authors.forename: Jennifer
authors.initials: J
authors.lastname: Matro
authors.forename: Louis M
authors.initials: LM
authors.lastname: Bell
authors.forename: Troy E
authors.initials: TE
authors.lastname: Dominguez
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
mesh_terms: D016022:Case-Control Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008480:Mediastinitis / Q000209:etiology*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013249:Sternum / Q000601:surgery; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000209:etiology*