Background. Klebsiella pneumoniae (K. pneumoniae) is one of the main causes of hospital infections (pneumonia, urinary tract infections, blood infections) in children with congenital heart disease in the intensive care unit. Multidrugresistant strains significantly complicate and treatment, but with rational antibiotic therapy it is possible to achieve effective treatment results. The aim. To analyze the detection of different strains of K. pneumoniae in children with congenital heart disease in the intensive care unit and the principles of antibiotic therapy in the treatment of infections caused by them. Materials and methods. At the Department Of Congenital Heart Disease Surgery for Newborns and Young Children, of the National Amosov Institute of Cardiovascular Surgery we examined 2548 patients in 2018-2020. Microbiological examination was performed in 370 children. Bacteriological culturing (sputum, blood) of the studied material on special medium for bacterial growth was analyzed on VITEK-2 analyzer for 72 hours. If a progenitor was seen, the sample was considered as positive, and the resulting columns were tested for sensitivity to antibiotics. Results. The bacterial growth was positive in 277 (75%) children, of whom K. pneumoniae was found in 98 (25%) patients in 138 tests. We obtained the following data: K. pneumoniae in 79 (57%) patients, extended spectrum betalactamase (ESBL)-producing K. pneumoniae in 47 (34%), carbapenem-resistant K. pneumoniae in 11 (8%), multiresistant K. pneumoniae in 1 (1%) patient. We prescribed standard or specific therapy in accordance with the recommendations for the treatment of infections caused by K. pneumoniae and its susceptibility to the antibiotics. Conclusions. It is important to follow the rules of rational antibiotic therapy (taking into account the sensitivity of the stimuli, pharmacodynamic and pharmacokinetic properties of the drugs) when treating infections. The spread of carbapenem-resistant strains of microorganisms leads to the loss of the possibility of using carbapenems as a reserve antibiotic, which significantly complicates the treatment of infections, and ceftazidime/avibactam should be the drug of choice in wards where the number of carbapenem-resistant strains equals to/exceeds 20%.

Junctional ectopic tachycardia (JET) is frequent acceleration of rhythm after complete repair of Tetralogy of Fallot. JET is associated with prolongation of been in the ICU and worsening of the prognosis. The present ways of preventing of JET cannot be routinely applied for all patients, so it needs to identify patients with high risk of JET emergence. Purpose. It needs to analyze cases of JET and identify risk factors for patients requiring Tetralogy of Fallot complete repair. Methods and materials. It was analyzed 81 patients with Tetralogy of Fallot after complete repair from 2014 until 2019 in National Amosov Institute of Cardiovascular Surgery. Results and discussion. Post-operative analysis shows that magnesium and potassium levels in blood were lower in patients with JET than in patients without JET (0.9 ± 0.41 and 1.14 ± 0.43, respectively, p < 0.05). Patients with JET were younger (7.8 ± 1.4 and 9.9 ± 1.6, respectively, p < 0.05), had lower body weight (8.1 ± 1.0 and 9.3 ± 0.9, respectively, p < 0.05) and higher heart rate in the pre-operative period (147.6 ± 11.4 and 124.9 ± 13.9, respectively, p < 0.05). It was found out that pre-operative respiratory cyanotic attacks are independent risk factors for JET. During the work we also found that the administration of beta-blockers in the pre-operative period significantly reduces the JET development (4 (26.6%) and 27 (40.9%) respectively, p <0.05). Conclusion.Younger age, lower body weight, and respiratory cyanotic attacks in the pre-operative period are unadjusted risk factors of the JET development in the early postoperative period. Blood magnesium and potassium concentrations are correlated factors in the JET development. Beta-blockers may be recommended for the prevention of JET in the early post-operative period in patients who have risk factors.

Delayed sternal closure in infants and children of the first months of life after the correction of complex congenital heart defects (CHD) can increase cardiac output. This is a forced measure due to the development of unstable hemodynamics, capillary leak syndrome and myocardial edema, as the sternotomy wound closure in the early postoperative period provides a compression effect on the function of the myocardium. The aim. To evaluate mortality and to detect predictors of adverse outcome as well as the incidence of non-cardiac complications in delayed sternal closure after surgical repair of CHD. Materials and methods. Twenty two children were studied. Six children died. Anesthetic management was provided using propofol (4–6 mg/kg/h) and fentanyl (5–10 μg/kg/h) infusions. Modified ultrafiltration was applied at the end of assisted circulation in all the cases. Sternal closure was performed on average on day 3 ± 2 after surgery. Results. Mortality odds ratio (OR) in patients with the mean arterial pressure (MAP) < 35 mmHg was 3.7; mortality OR in patients with SVO2 < 40 % was 0.94; mortality OR in patients with blood lactate > 10 mmol/L in the first three days of postoperative intensive care was 2.1. Conclusions. Delayed sternal closure is an acceptable method of maintaining cardiac output in young infants with CHD in postoperative period. High blood lactate (> 10 mmol/L) and especially its further growth, as well as MAP < 35 mmHg, can predict adverse outcomes of cardiac surgery with open sternotomy.