ArticlePediatric nephrology (Berlin, Germany)2018
Fluid overload independent of acute kidney injury predicts poor outcomes in neonates following congenital heart surgery.
Article in Pediatric nephrology (Berlin, Germany), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 4 of them syntheses that pooled it.
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Who cites it
39 citing papers in PubMed, 4 syntheses or guidelines pooled it, 74 citations in OpenAlex.
- Risk factors and mortality of postoperative acute kidney injury (AKI) in newborns across geographical regions, surgical type, and national economic levels: a systematic review and meta-analysis.European journal of medical research · 2025Pooled it
- Association between fluid overload and mortality in newborns: a systematic review and meta-analysis.Pediatric nephrology (Berlin, Germany) · 2022Pooled it
- A meta-analysis of the incidence rate of postoperative acute kidney injury in patients with congenital heart disease.BMC nephrology · 2020Pooled it
- Association of postoperative fluid overload with adverse outcomes after congenital heart surgery: a systematic review and dose-response meta-analysis.Pediatric nephrology (Berlin, Germany) · 2020Pooled it
- Acute kidney injury after in-hospital cardiac arrest.Resuscitation · 2021Trial
- Exploring Racial and Ethnic Disparities in Outcomes Following Pediatric Cardiac Surgery: A NEPHRON Study Analysis.Pediatric cardiology · 2026Article
- Fluid balance during PICU stay in children after cardiac surgery with cardiopulmonary bypass.European journal of pediatrics · 2026Article
- A Novel, Interpretable Machine Learning Model Predicts Furosemide Dosing After Congenital Cardiac Surgery.Pediatric cardiology · 2026Article
- Interferon-γ and interleukin-17A associations with vascular dysfunction following paediatric cardiac surgery with cardiopulmonary bypass.Cardiology in the young · 2026Article
- Acute Effects of Aminophylline Effects on Hemodynamic Parameters and Fluid Balance in Pediatric Cardiac Intensive Care Patients: Machine Learning Insights Using High Fidelity Data.Pediatric cardiology · 2025Article
- Syndecan-1 as a Biomarker for Fluid Overload After High-Risk Pediatric Cardiac Surgery: A Pilot Study.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2025Observational
- Urine biomarkers, acute kidney injury, and fluid overload in neonatal cardiac surgery.Cardiology in the young · 2025Article
- Fluid Overload and AKI After the Norwood Operation: The Correlation and Characterization of Routine Clinical Markers.Pediatric cardiology · 2024Article
- An update on the role of fluid overload in the prediction of outcome in acute kidney injury.Pediatric nephrology (Berlin, Germany) · 2024Review
- An evaluation of the outcomes associated with peritoneal catheter use in neonates undergoing cardiac surgery: A multicenter study.JTCVS open · 2024Article
- Persistent acute kidney injury and fluid accumulation with outcomes after the Norwood procedure: report from NEPHRON.Pediatric nephrology (Berlin, Germany) · 2024Article
- Fluid assessment, fluid balance, and fluid overload in sick children: a report from the Pediatric Acute Disease Quality Initiative (ADQI) conference.Pediatric nephrology (Berlin, Germany) · 2024Article
- Immune urinary biomarkers predict infant cardiac surgery-associated acute kidney injury.Pediatric nephrology (Berlin, Germany) · 2024Article
- Activation of renal epithelial NaFrontiers in pediatrics · 2024Article
- Article
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundFluid overload (FO) is common after neonatal congenital heart surgery and may contribute to mortality and morbidity. It is unclear if the effects of FO are independent of acute kidney injury (AKI).
methodsThis was a retrospective cohort study which examined neonates (age < 30 days) who underwent cardiopulmonary bypass in a university-affiliated children's hospital between 20 October 2010 and 31 December 2012. Demographic information, risk adjustment for congenital heart surgery score, surgery type, cardiopulmonary bypass time, cross-clamp time, and vasoactive inotrope score were recorded. FO [(fluid in-out)/pre-operative weight] and AKI defined by Kidney Disease Improving Global Outcomes serum creatinine criteria were calculated. Outcomes were all-cause, in-hospital mortality and median postoperative hospital and intensive care unit lengths of stay.
resultsOverall, 167 neonates underwent cardiac surgery using cardiopulmonary bypass in the study period, of whom 117 met the inclusion criteria. Of the 117 neonates included in the study, 76 (65%) patients developed significant FO (>10%), and 25 (21%) developed AKI ≥ Stage 2. When analyzed as FO cohorts (< 10%,10-20%, > 20% FO), patients with greater FO were more likely to have AKI (9.8 vs. 18.2 vs. 52.4%, respectively, with AKI ≥ stage 2; p = 0.013) and a higher vasoactive-inotrope score, and be premature. In the multivariable regression analyses of patients without AKI, FO was independently associated with hospital and intensive care unit lengths of stay [0.322 extra days (p = 0.029) and 0.468 extra days (p < 0.001), respectively, per 1% FO increase). In all patients, FO was also associated with mortality [odds ratio 1.058 (5.8% greater odds of mortality per 1% FO increase); 95% confidence interval 1.008,1.125;p = 0.032].
conclusionsFluid overload is an important independent contributor to outcomes in neonates following congenital heart surgery. Careful fluid management after cardiac surgery in neonates with and without AKI is warranted.
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