Advances in neonatal care : official journal of the National Association of Neonatal Nurses · 2026
Enhanced Recovery After Surgery (ERAS) in Neonatal Cardiac Care: A Case Report of Nursing-Led Management for Obstructed Mixed-Type Total Anomalous Pulmonary Venous Connection.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
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Wang Jingna, Dan Na, Zhang Yuxia
Аннотация
BACKGROUND: Obstructed mixed-type total anomalous pulmonary venous connection (TAPVC) is a rare life-threatening congenital heart defect requiring urgent, high-risk surgery. Postoperative care is complex and fraught with complications. Enhanced recovery after surgery (ERAS) is a multimodal, evidence-based approach to optimize perioperative care, yet its application in neonatal cardiac surgery is nascent.
CLINICAL FINDINGS: A 12-day-old male infant presented with lethargy, poor feeding, and severe respiratory distress (SpO 2 80%-85%), requiring immediate intubation. Examination revealed diminished mental responsiveness and signs of poor perfusion.
PRIMARY DIAGNOSIS: Obstructed mixed-typeTAPVC with an atrial septal defect, a ventricular septal defect, a patent ductus arteriosus, and severe pulmonary hypertension.
INTERVENTIONS: The infant underwent surgical correction. Postoperatively, a comprehensive, nursing-led ERAS protocol was implemented. Core interventions encompassed goal-directed fluid therapy, proactive respiratory support to prevent pulmonary hypertensive crises, standardized sedation, early complication surveillance (thrombosis, capillary leak syndrome), and structured early rehabilitation.
OUTCOMES: The infant was successfully weaned from mechanical ventilation on postoperative Day 5, achieved full oral feeding by Day 13, and was discharged on Day 18. This recovery timeline compares favorably to published data for similar complex cases. At the 3-month follow-up, he demonstrated age-appropriate growth and development with no significant cardiac sequelae.
PRACTICE RECOMMENDATIONS: A structured, nursing-driven ERAS protocol is a valuable clinical tool to enhance outcomes, accelerate recovery, and reduce complications in high-risk neonatal cardiac surgery. This case affirms the pivotal role of neonatal nurses in perioperative care.
CLINICAL FINDINGS: A 12-day-old male infant presented with lethargy, poor feeding, and severe respiratory distress (SpO 2 80%-85%), requiring immediate intubation. Examination revealed diminished mental responsiveness and signs of poor perfusion.
PRIMARY DIAGNOSIS: Obstructed mixed-typeTAPVC with an atrial septal defect, a ventricular septal defect, a patent ductus arteriosus, and severe pulmonary hypertension.
INTERVENTIONS: The infant underwent surgical correction. Postoperatively, a comprehensive, nursing-led ERAS protocol was implemented. Core interventions encompassed goal-directed fluid therapy, proactive respiratory support to prevent pulmonary hypertensive crises, standardized sedation, early complication surveillance (thrombosis, capillary leak syndrome), and structured early rehabilitation.
OUTCOMES: The infant was successfully weaned from mechanical ventilation on postoperative Day 5, achieved full oral feeding by Day 13, and was discharged on Day 18. This recovery timeline compares favorably to published data for similar complex cases. At the 3-month follow-up, he demonstrated age-appropriate growth and development with no significant cardiac sequelae.
PRACTICE RECOMMENDATIONS: A structured, nursing-driven ERAS protocol is a valuable clinical tool to enhance outcomes, accelerate recovery, and reduce complications in high-risk neonatal cardiac surgery. This case affirms the pivotal role of neonatal nurses in perioperative care.