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NICU guideline identifier

Cardiac - pre-operative cardiac care in NICU

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Cardiac Surgery-Pre-Operative Skin preparation

Pre-operative anti -Staphylococcal Bundle

  • All children undergoing cardiac surgery will have a total body wipe with chlorhexidine 2% wash cloths the night before and morning of surgery. 
  • Mupirocin 2% nasal (topical preparation not approved for neonatal use) ointment to be applied to both nostrils the night before and on the morning of surgery. 
  • The ointment is to be charted BD for 5 days and the tube should go into a plastic bag attached to the baby's notes so that it can be continued in PICU. 
  • Nasal swabs to be done on admission to NICU and if results available and negative for Staphylococcus, the mupirocin steps can be omitted.
  • Place pre-operative checklist sticker into patient notes.

Investigations Required Prior to Cardiac Catheter

  • Group and Cross match 
  • CXR 
  • ECHO 
  • ECG 
  • FBC 
  • Electrolytes 
  • Urea and Creatinine 
  • Gas and lactate if intubated or unwell 

Investigations Required Prior to Surgery

Test Details
Group and Cross Match
  •  On the request form write clearly "pt is for cardiac surgery" and fill in transfusion history so sample will be valid for 7 days rather than 72 hours.
  • If patient changes name the sample will no longer be valid so a repeat sample will need to be sent.
  • Group and Crossmatch will be valid for child < 4 months even if transfused as long as they have not left the hospital.
  • If 22q11 deletion and t-cell abnormalities or unsure of lymphocyte function you may need irradiated blood, please confirm this with the surgeon or anaesthetist before ordering.
Newborn Metabolic Screening
  • Needs to be sent prior to bypass so sample should be sent even if prior to 48 hours otherwise follow the NICU protocol.
  • If missed and not done prior to bypass the first sample should be sent 48-72 hours after surgery and a repeat sample sent in 3 months.
Other Bloods 
  • FBC
  • Urea & Creatinine
  • Electrolytes
  • Gas & Lactate if intubated or unwell
  • Coags as requested by anaethetist or surgeon
Fish for 22q11 deletion
  • Required on all infants who have Conotruncal abnormalities; Tetralogy of Fallot, Truncus, Interrupted Aortic Arch and on children with dysmorphisms or concern for chromosomal anomalies.
  • As all bypass cases will be transfused any chromosomal testing needs to be done pre operatively. 
T Cell (count and function)
  • To be sent on all children with Interrupted Aortic Arch
  • Send for known 22q11 deletion
CXR Within 1 month of surgery or if respiratory status has changed since last one. 
ECG  Within 2 weeks of surgery. Pager for ECG tech 93 5367 
Ultrasound Renal and  Head ultrasounds required on any infant undergoing aortic arch surgery e.g. Norwood or Coarctation of the Aorta.


  • Surgical consent is obtained by the surgeon.
  • Anaesthetic consent is obtained by the anaesthetist or anaesthetic registrar.
  • Consent for Blood Transfusion must be obtained prior to surgery - infants with known or possible immune deficiency (22q11 possible DiGeorge) should receive irradiated blood.

Ongoing care in NICU

Questions about the care of babies in NICU should be directed to the consult cell phone (0211808238) Mon-Fri 8am to 5pm or the Cardiologist on call.

To refer new patients to the Cardiology Service the Neonatologist should call the Cardiologist on Call.

Questions about the scheduling of surgery can be answered by booking clerk at ext 23619

Parental Queries

If the parents of cardiac surgical patients have questions about the process around surgery or what will happen post-op, please call the Nurse Practitioners, Ana Kennedy on 021332861 or Marion Hamer on 021 983986 who will be happy to come up and speak to the parents.

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Document Control

  • Date last published: 02 April 2018
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years