Journal of Pediatric Perspectives

Journal of Pediatric Perspectives

Serum Ferritin and Clinical Outcomes in Children Undergoing Pediatric Cardiac Surgery

Document Type : original article

Authors
Naycka Onofre Witt Batista 1
Humberto Holmer Fiori 2
Nadia Camilato Ferraz Knop 3
1 Postgraduate Program in Pediatrics and Child Health, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
2 Department of Pediatrics, Graduate Program in Pediatrics and Child Health, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.
3 Pediatric Resident Physician, Vila Velha University, ES, Alzir Bernardino Alves Children's and Maternity Hospital (HIMABA), Brazil.
10.22038/jpp.2026.94493.5652
Abstract
Background: Hyperferritinemia is a prognostic marker in critical illness, but its role in postoperative outcomes of pediatric congenital heart defects remains poorly defined, especially in resource-limited settings. This study evaluated early serum ferritin as a predictor of outcomes after congenital heart surgery and its association with the Pediatric Index of Mortality 3 (PIM 3) score.
Methods: A single-center prospective cohort study was conducted from April 2023 to October 2024 at a tertiary referral center in southeastern Brazil. Patients aged 29 days to 18 years, of both sexes, admitted to the pediatric intensive care unit (PICU) after congenital heart surgery were included and categorized according to the presence of cyanotic or acyanotic heart disease. Group comparisons were performed using Fisher’s exact test, chi-square test, Student’s t-test, ANOVA, or Kruskal–Wallis test, with statistical significance set at p < 0.05.
Results: A total of 105 patients were included. Median ferritin was higher in patients with PICU stays < 7 days (183 ng/mL; p = 0.004) and was significantly associated with a PIM 3 score ≥ 5% (642 ng/mL; p < 0.006). Cyanotic patients had longer PICU stays (11.0 vs. 7.2 days; p = 0.02), longer use of vasoactive drugs (3.8 vs. 2.6 days; p = 0.01), and accounted for all deaths (p < 0.001). Hemoglobin and hematocrit were also significantly higher in cyanotic patients (14 vs. 13 g/dL and 40% vs. 37%; p < 0.001).
Conclusions: Serum ferritin may serve as a marker of secondary outcomes and aid early risk stratification in congenital heart defect patients in the PICU.
Keywords
Congenital
Heart defects
Hyperferritinemia
Intensive care units
Mortality
Outcomes
Pediatric
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Journal of Pediatric Perspectives
Volume 14, Issue 4
April 2026
Pages 20028-20039