Postoperative cardiac intensive care outcome for Down syndrome children

OBJECTIVE: The purpose of this study is to review the postoperative intensive care unit (ICU) course, complications and outcome of Down's syndrome children undergoing surgical repair of congenital heart diseases (CHD).

METHODS: A retrospective chart review analysis of intensive care course and outcome of Down syndrome children undergoing surgical repair of congenital heart diseases (CHD) from May 2000 to May 2004. The study was conducted in the Pediatric Cardiac ICU, King Abdul- Aziz Cardiac Center of National Guard Hospital, Riyadh, Kingdom of Saudi Arabia. All Down's syndrome children who had surgical repair during the study period were included.

RESULTS: During the study period, 80 patients (31 males and 49 females) with Down's syndrome had surgical repair of CHD. Their average weight was 5.8 ± 0.3 kg and age was 11.7 ± 1.5 months. Their primary surgical interventions were as follow: atrio-ventricular septal defect repair (44), ventricular septal defect closure (24), patent ductus arteriosus ligation (6), secundum atrial septal defect closure (3), and tetralogy of Fallot repair (3). Postoperative complications occurred in 19 patients (23%). Few patients had more than one complication. The compilations were as follow: 8 patients (10%) had sepsis, 3 (4%) required permanent pacemaker insertion, 4 (5%) had chylothorax, 2 (2.5%) had life threatening pulmonary hypertensive crisis with full recovery after proper managements, 5 (6%) needed prolong intubation, more than 7 days, and one patient (1.2%) required tracheostomy. All patients survived and were discharged home except one (1.2%) who expired 8 weeks after surgery from sepsis and multi-organ failure.

CONCLUSION: Patients with Down's syndrome undergoing CHD repair had an acceptable postoperative morbidity and low mortality. Their results are comparable to non-Down's cardiac patients. From an ICU perspective, the majority of these patients do well postoperatively with good ICU outcome.