Associations With Prolonged Post-Extubation Noninvasive Respiratory Support in Neonates Following the Norwood Procedure: A Two-Center Retrospective Cohort Study, 2019–2023

Objective: The use of post-extubation respiratory support in single-ventricle neonates undergoing the Norwood procedure is poorly described. We investigated the patterns of respiratory support following extubation as well as factors associated with prolonged exposure to post-extubation noninvasive respiratory support (NRS), defined as greater than or equal to 72 hours, in neonates recovering from the Norwood procedure. Design: Two-center retrospective cohort study. Setting: North American pediatric cardiac ICUs. Patients: Neonates (< 1 mo at the time of surgery) undergoing a Norwood procedure between January 1, 2019, and December 31, 2023. Measurements and Main Results: The study included 127 neonates of whom 60 (47%) experienced the primary outcome of prolonged NRS. In multivariable analysis, the presence of an airway anomaly (adjusted odds ratio [aOR] 3.6; 95% CI, 1.4–8.9; p = 0.006), an unplanned surgical or catheter-based reintervention (aOR 3.2; 95% CI, 1.3–7.5; p = 0.010), and longer postoperative mechanical ventilation (aOR 1.1; 95% CI, 1.0–1.2; p = 0.018) were independently associated with prolonged NRS. Patients with prolonged NRS had lower weight-for-age z score at cardiac ICU (CICU) discharge (–2.11 vs. –1.14; p = 0.004), longer CICU length of stay (25.1 vs. 11.1 d; p < 0.001), and longer postoperative sedative exposure (59.8 vs. 16.8 d; p < 0.001). Conclusions: Prolonged NRS is common in neonates following the Norwood procedure. Patients receiving prolonged NRS experience worse clinical outcomes.