Acute gastrointestinal injury after pediatric cardiac surgery: A single-center prospective observational study

Background Acute gastrointestinal injury (AGI) encompasses structural or functional gastrointestinal tract dysfunction arising from various stress conditions in critically ill patients. Although it is a well recognized complication in adult cardiovascular surgery patients, its prevalence and risk factors in pediatric population remain unclear. This study sought to: (1) investigate the incidence and prognostic influence of AGI, and (2) identify the risk factors and clinical characteristics associated with AGI in pediatric patients undergoing open-heart surgery with cardiopulmonary bypass(‌CPB). Methods This was a prospective observational study conducted in a single center. The pediatric patients undergoing open-heart surgery with CPB between April 2021 and December 2021 were included. Data collection included demographics, operative details, gastrointestinal symptoms, intra-abdominal pressure(IAP), anthropometric parameters of abdominal morphology, and clinical outcomes. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for AGI. A P-value < 0.05 was considered statistically significant. Results Analysis of 137 pediatric patients revealed that AGI occurred in 60 patients (43.8%) following open-heart surgery with CPB. Patients with AGI experienced a higher rates of low cardiac output syndrome(LCOS), postoperative infections, and composite outcome (P < 0.05). Furthermore, these patients required greater vasopressor support and experienced longer durations of mechanical ventilation and ICU/hospital stays. Multivariable logistic regression identified AGI as an independent risk factor for the composite outcome (odds ratio [OR] 3.44, 95% confidence interval [CI] 1.28 ~ 9.27; P = 0.015). Multivariate analysis also identified a longer ‌CPB time (OR 1.01, 95% CI: 1.00 ~ 1.02; P = 0.007) and a higher intraoperative Vasoactive-Inotropic Score (VIS) (OR 1.11, 95% CI: 1.02 ~ 1.20; P = 0.013) as independent perioperative risk factors for AGI. Postoperative abdominal morphology demonstrated significant alterations, which were more pronounced in the AGI group. Conclusion AGI represents a significant clinical concern in pediatric cardiac surgery, where its presence is consistently linked to an adverse postoperative outcome. Prolonged CPB duration and high-dose intraoperative vasoactive drug administration are potential predictive factors for AGI development. Notably, early postoperative alterations in abdominal anthropometric measurements may provide an early non-invasive warning indicator for AGI identification, enabling timely intervention and potentially improving clinical outcomes. Trial registration ClinicalTrials.gov Identifier ChiCTR2100044840 on March 30, 2021