Child/Adolescent Health

Researchers determine risk factors for deadly infection after open-chest surgeries in children

Children who require repairs to their hearts or lungs often undergo a surgical procedure called median sternotomy. The procedure provides surgeons access to those organs after they make an incision along the breast bone and then crack the bone. One rare complication of the surgery is mediastinitis, a potentially fatal infection of the mediastinum. This is the area between the lungs that includes the heart, large blood vessels, windpipe, esophagus, thymus gland, and connective tissues.

Researchers from the University of Pennsylvania Center for Education and Research on Therapeutics and Children's Hospital of Philadelphia studied medical records for 224 children, who underwent median sternotomies at the pediatric hospital to determine the risk factors for mediastinitis. The 43 children who developed the infection shared common characteristics, which may be used to determine who is at risk.

First, the children frequently had underlying genetic syndromes or chromosomal abnormalities. These conditions may be associated with illnesses in addition to the cardiac condition, a weakened immune system, and more complex problems that required longer or more difficult surgeries.

The researchers also found that a score of four or more on the American Society of Anesthesiologists (ASA) classification scale was also a potential risk factor for mediastinitis. The ASA score places patients into six categories based on their health before surgery. A score of four indicates the patient has a severe systemic disease that is a constant threat to life.

The final risk factor was use of epicardial pacing wires for more than 3 days. Those wires are routinely inserted in the chest to manage irregular heart rhythms. The combination of the severity of the child's illness requiring the wires to be in place for a prolonged period and the presence of a foreign body may explain why the infection develops.

This study was funded in part by the Agency for Healthcare Research and Quality (HS10399).

See "Risk factors for mediastinitis following median sternotomy in children," by Jessica Kagen, B.A., Ebbing Lautenbach, M.D., M.P.H., M.S.C.E., Warren B. Bilker, Ph.D., and others in the July 2007 Pediatric Infectious Disease Journal 26(7), pp. 613-618.

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