Early cardiac rehabilitation in ICU for infants after complex congenital heart disease surgery: a retrospective case series.

Background: Complex congenital heart disease (CHD) has long been a significant cause of infant mortality and severe morbidity. However, pediatric cardiac rehabilitation (CR) is gaining recognition, and evidence regarding postoperative ICU phase CR for infants with CHD remains scarce. Methods: This was a retrospective case series, we reviewed clinical data for 10 infants with complex CHD who received an early, individualized CR program during the postoperative ICU phase. The rehabilitation was initiated between postoperative days 5-15 (median 9). The program was based on an exercise prescription, and integrated multidimensional interventions, including respiratory training, gross motor function training, nutritional support, and developmental care. Results: All infants were critically ill postoperatively requiring various forms of life-support therapy in the ICU. No serious adverse events related to rehabilitation occurred; transient fluctuations in vital signs resolved promptly with temporary pauses in therapy. Eight infants were discharged home after recovery, and two were transferred to other institutions. Functional improvements were observed across respiratory, feeding, neuromotor, and circulatory domains during the ICU stay. Conclusion: For infants with complex CHD, early initiation of a cardiac rehabilitation program during the ICU phase appears safe and feasible when implemented under multidisciplinary assessment and close clinical monitoring. This approach may support functional recovery across cardiopulmonary and neuromotor domains during a critical developmental window.