Predicting prolonged mechanical ventilation in neonates after cardiac surgery: development of a nomogram for risk prediction based on preoperative and intraoperative factors

Background: Despite improvements in neonatal cardiac surgery, prolonged mechanical ventilation remains a prevalent postoperative complication. This study was designed to build a prolonged mechanical ventilation prediction model based on preoperative and intraoperative factors in neonates (0–28 days) after cardiac surgery. Methods: A retrospective analysis was conducted on perioperative data of 385 newborns undergoing cardiac surgery at Guangdong Provincial People’s Hospital from 2018 to 2024. Prolonged mechanical ventilation was defined as postoperative mechanical ventilation duration >7 days. Results: Multivariate logistic regression identified independent predictors, visualised via a nomogram. Model performance was assessed by area under receiver operating characteristic curve analysis, calibration plots, and decision curve analysis. Multivariate logistic regression analysis identified airway anomalies (odds ratio = 2.280, 95% confidence interval 1.217–4.271, P = 0.010), preoperative mechanical ventilation (odds ratio = 2.244, 95% confidence interval 1.283–3.925, P = 0.005), radical surgery (odds ratio = 0.220, 95% confidence interval 0.091–0.533, P < 0.001), intraoperative red blood cell transfusion volumes (odds ratio = 1.529, 95% confidence interval 1.065–2.195, P = 0.021), intraoperative elevated lactate levels (odds ratio = 2.352, 95% confidence interval 1.256–4.403, P = 0.008), and higher vasoactive-inotropic score at the end of surgery (odds ratio = 1.060, 95% confidence interval 1.023–1.199, P = 0.001) as risk factors for prolonged mechanical ventilation. The nomogram achieved an area under the receiver operating curve of 0.784, with robust calibration and clinical utility. Prolonged mechanical ventilation was associated with prolonged hospital stay (median 23 vs. 16 days, P < 0.001) and increased hospital mortality (12.3% vs. 1.1%, P < 0.001). Conclusions: This model accurately stratifies the risks of prolonged mechanical ventilation in neonates after cardiac surgery, potentially guiding postoperative management.