Impact of perioperative oxygen partial pressure management on neonatal organ function during cardiopulmonary bypass

Zhang Xiaojuan; Miao Na; Wang Xiaonan; Lin Lin; Yang Xiaofang; Wang Jialu; Fan Xing; Zhao Ju

doi:10.13498/j.cnki.chin.j.ecc.2025.04.05

Abstract：Objective To evaluate the effect of high versus low oxygen partial pressure(PaO2)management on organ function in neonates undergoing cardiac surgery with cardiopulmonary bypass(CPB).Methods Neonates who underwent CPB-supported cardiac surgery at our institution from January 2023 to December 2024 were stratified into two groups:a high-PaO2 group(PaO2>200 mmHg)and a low-PaO2 group(PaO2≤200 mmHg).Preoperative and postoperative serum total bilirubin,creatinine,and serial lactate levels(pre-incision,intraoperative,and 6 hours post-CPB)were analyzed.Organ dysfunction and perfusion status were compared between groups.Results Sixty neonates(male:41;female:19;mean age:11.29±7.50 days;mean weight:3.39±0.61 kg)were included,with 30 patients in each group.High-PaO2 group:Postoperative total bilirubin and creatinine levels increased significantly compared to preoperative baselines(P<0.05).Intraoperative and 6-hour postoperative lactate levels were elevated versus pre-incision values(P<0.05).Low-PaO2 group:Postoperative bilirubin and creatinine level showed non-significant increases.Lactate levels rose intraoperatively and at 6 hours postoperatively(P<0.05).Intergroup comparisons revealed higher postoperative bilirubin and creatinine in the high-PaO2 group,though differences were non-significant.Intraoperative and 6-hour lactate levels trended higher in the high-PaO2 group.Conclusion High PaO2 management during neonatal CPB is associated with aggravated postoperative hepatic/renal dysfunction and impaired systemic perfusion.Restrictive oxygen strategies(PaO2≤200 mmHg)may mitigate organ injury and improve lactate clearance.