Abstract
Background: Respiratory infections are considered a potential risk of adverse events in children undergoing surgery. Rhinovirus is a common cause of respiratory infections and congenital heart disease is a risk factor for severe rhinovirus infection. However, we do not know what the impact of, clinical or subclinical, rhinovirus infections is on postoperative course following congenital heart surgery in children. Based on our clinical experience, one case-controlled study, and a case reported in the literature, we hypothesize that paediatric patients with per-operative rhinovirus positive Polymerase Chain Reaction testing have a longer paediatric intensive care unit admission, compared to children who test negative. Methods/Design: This is a prospective single-center observational study in the Leiden University Medical Center with approximately 250 children (<12 years) undergoing elective cardiac surgery, for congenital heart disease. The parents/guardians of the children will be asked to fill out a questionnaire, to asses respiratory symptoms in the last weeks, before the operation of their child. In the operating theatre, a nasopharyngeal swab will be collected. Clinical data will be collected daily during paediatric intensive care admission and paediatric intensive care unit and hospital length of stay will be recorded. If children are still intubated at day 4, a second nasopharyngeal swab and residual blood will be collected. The samples will be tested for rhinovirus with polymerase chain reaction. Primary outcome is the paediatric intensive care unit length of stay in per-operative rhinovirus-positive compared to rhinovirus-negative patients. Discussion: This is the first study to screen children for rhinovirus before undergoing cardiac surgery and to study the effects on paediatric intensive care unit length of stay. Furthermore, we aim to identify children at risk for prolonged paediatric intensive care admission after cardiac surgery.
Highlights
Respiratory infections are considered a potential risk of adverse events in children undergoing surgery
We aim to identify children at risk for prolonged paediatric intensive care admission after cardiac surgery
Paediatric patients with postoperative symptomatic rhinovirus infection appear to have a more complicated and prolonged postoperative course compared to other patients undergoing cardiac surgery (unpublished Leiden University Medical Center (LUMC) data)
Summary
Respiratory infections are considered a potential risk of adverse events in children undergoing surgery. Upper respiratory tract infections are considered to carry a potential risk of adverse events in children undergoing surgery. Surgery in children with symptomatic upper respiratory tract infection is commonly postponed, because of the increased risk of complications of anaesthesia in these patients [4]. Children with a clinically apparent upper respiratory tract infection at the time of cardiac surgery have higher incidences of respiratory complications, multiple complications, postoperative infections and significantly longer paediatric intensive care unit (PICU) admission [10]. Simsic et al described a case of nine months old boy with rhinovirus infection and a complicated course after cardiac surgery Based on this case the authors screen all their paediatric patients with single-ventricle congenital heart disease by polymerase chain reaction (PCR) for respiratory viruses. In this study the rhinovirus positive patients had a significantly longer intubation time and a three times longer PICU length of stay [12]
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