title: Impact of Viral Respiratory Pathogens on Outcomes After Pediatric Cardiac Surgery.
abstract: OBJECTIVE
  Viral respiratory infection is commonly considered a relative contraindication to elective cardiac surgery. We aimed to determine the frequency and outcomes of symptomatic viral respiratory infection in pediatric cardiac surgical patients.
  
  
  METHODS
  Retrospective cohort study of children undergoing cardiac surgery. Symptomatic children were tested using a multiplex Polymerase Chain Reaction (respiratory virus polymerase chain reaction) panel capturing nine respiratory viruses. Tests performed between 72 prior to and 48 hours after PICU admission were included. Mortality, length of stay in PICU, and intubation duration were investigated as outcomes.
  
  
  METHODS
  Tertiary PICU providing state-wide pediatric cardiac services.
  
  
  METHODS
  Children less than 18 years admitted January 1, 2008 to November 29, 2014 for cardiac surgery.
  
  
  RESULTS
  Respiratory virus polymerase chain reaction was positive in 73 (4.2%) of 1,737 pediatric cardiac surgical admissions, including 13 children with multiple viruses detected. Commonly detected viruses included rhino/enterovirus (48%), adenovirus (32%), parainfluenza virus 3 (10%), and respiratory syncytial virus (3%). Pediatric Index of Mortality 2, Aristotle scores, and cardiopulmonary bypass times were similar between virus positive and negative/untested cohorts. Respiratory virus polymerase chain reaction positive patients had a median 2.0 days greater PICU length of stay (p < 0.001) and longer intubation duration (p < 0.001). Multivariate analysis adjusting for age, Aristotle score, cardiopulmonary bypass duration, and need for preoperative PICU admission confirmed that virus positive patients had significantly greater intubation duration and PICU length of stay (p < 0.001). Virus positive patients were more likely to require PICU admission greater than 4 days (odds ratio, 3.5; 95% CI, 1.9-6.2) and more likely to require intubation greater than 48 hours (odds ratio, 2.5; 95% CI, 1.4-4.7). There was no difference in mortality. No association was found between coinfection and outcomes.
  
  
  CONCLUSIONS
  Pediatric cardiac surgical patients with a respiratory virus detected at PICU admission had prolonged postoperative recovery with increased length of stay and duration of intubation. Our results suggest that postponing cardiac surgery in children with symptomatic viral respiratory infection is appropriate, unless the benefits of early surgery outweigh the risk of prolonged ventilation and PICU stay.
authors.affiliation: 1Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, Australia. 2Paediatric Critical Care Research Group, Mater Research, University of Queensland, Brisbane, Australia. 3University of Queensland, Brisbane, Australia. 4Queensland Paediatric Cardiac Service, Lady Cilento Children's Hospital, Brisbane, Australia. 5Infection Management and Prevention Service, Lady Cilento Children's Hospital, Brisbane, Australia. 6Mater Pathology, Mater Misericordiae Ltd, Brisbane, Australia. 7Department of Cardiovascular Surgery, John Hopkins all Children's Hospital, St. Petersburg, FL. 8Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Katie
authors.initials: K
authors.lastname: Moynihan
authors.forename: Andrew
authors.initials: A
authors.lastname: Barlow
authors.forename: Nelson
authors.initials: N
authors.lastname: Alphonso
authors.forename: Ben
authors.initials: B
authors.lastname: Anderson
authors.forename: Janelle
authors.initials: J
authors.lastname: Johnson
authors.forename: Clare
authors.initials: C
authors.lastname: Nourse
authors.forename: Sanmarié
authors.initials: S
authors.lastname: Schlebusch
authors.forename: Tom R
authors.initials: TR
authors.lastname: Karl
authors.forename: Luregn J
authors.initials: LJ
authors.lastname: Schlapbach
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D000075202:Contraindications; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011182:Postoperative Care / Q000706:statistics & numerical data; D057234:Preoperative Period; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012141:Respiratory Tract Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality; D012189:Retrospective Studies; D014777:Virus Diseases / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality