title: Determinants of early outcome after neonatal cardiac surgery in a developing country.
abstract: OBJECTIVE
  Significant technologic advances have improved outcomes in neonatal cardiac surgery over the past 3 decades. However, outcomes might be different in developing countries with resource limitations. We sought to identify the determinants of early outcome after neonatal cardiac surgery in a tertiary referral center in South India.
  
  
  METHODS
  Hospital records of 330 consecutive neonates who underwent surgical intervention between January 1999 and April 2006 were reviewed, and perioperative variables were recorded. Main outcome measures were 30-day mortality, postoperative bloodstream infection, and hospital stay of longer than 10 days. Multivariate logistic regression analysis was performed.
  
  
  RESULTS
  Overall mortality was 8.8%. Mortality significantly decreased from 21.4% before 2002 to 4.3% after 2002 (3.2% for corrective operations, P < .0001). The prevalence of postoperative bloodstream infection remained the same, whereas surgical site infection and hospital stay significantly increased after 2002. Predictors of outcomes on multivariate analysis were as follows: (1) mortality--operation before 2002 (odds ratio, 5.5), age less than 7 days (odds ratio, 3.8), preoperative antibiotic use (odds ratio, 5.6), and postoperative exchange transfusion (odds ratio, 14.9); (2) postoperative bloodstream infection (21.2%)--use of cardiopulmonary bypass (odds ratio, 2.0), reintubation (odds ratio, 7.7), and surgical site infection (odds ratio, 4.1); and (3) hospital stay of longer than 10 days (61.2%)--use of cardiopulmonary bypass (odds ratio, 2.8), delayed sternal closure (odds ratio, 3.6), reintubation (odds ratio, 12.1), surgical site infection (odds ratio, 13.8), and postoperative antibiotic use (odds ratio, 4.4).
  
  
  CONCLUSIONS
  With increasing experience, neonatal cardiac surgery can be performed with excellent outcomes in developing countries with resource limitations. Infectious complications contribute significantly to morbidity and mortality, and improvements in infection-control practices should be emphasized to improve outcomes further.
authors.affiliation: Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Center, Kerala, India.
authors.forename: Kinjal D
authors.initials: KD
authors.lastname: Bakshi
authors.forename: Balu
authors.initials: B
authors.lastname: Vaidyanathan
authors.forename: Karimassery R
authors.initials: KR
authors.lastname: Sundaram
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Roth
authors.forename: Krishnanaik
authors.initials: K
authors.lastname: Shivaprakasha
authors.forename: Suresh G
authors.initials: SG
authors.lastname: Rao
authors.forename: Suresh G
authors.initials: SG
authors.lastname: Nair
authors.forename: Suresh
authors.initials: S
authors.lastname: Chengode
authors.forename: R Krishna
authors.initials: RK
authors.lastname: Kumar
mesh_terms: D005260:Female; D006331:Heart Diseases / Q000151:congenital* / Q000601:surgery*; D006801:Humans; D007194:India; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome