Hostname: page-component-8448b6f56d-c47g7 Total loading time: 0 Render date: 2024-04-18T07:18:43.635Z Has data issue: false hasContentIssue false
  • English
  • Français

Morbidity and mortality after surgery for congenital cardiac disease in the infant born with low weight

Published online by Cambridge University Press:  18 December 2009

Anne M. Ades MD ,
Troy E. Dominguez MD ,
Susan C. Nicolson MD ,
James W. Gaynor MD ,
Thomas L. Spray MD ,
Gil Wernovsky MD  and
Sarah Tabbutt MD, PhD
Anne M. Ades MD*
Affiliation:
Department of Pediatrics, Division of Neonatology, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
Troy E. Dominguez MD
Affiliation:
Department of Anesthesia and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
Susan C. Nicolson MD
Affiliation:
Department of Anesthesia and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
James W. Gaynor MD
Affiliation:
Department of Surgery, Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
Thomas L. Spray MD
Affiliation:
Department of Surgery, Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
Gil Wernovsky MD
Affiliation:
Department of Anesthesia and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA Department of Pediatrics, Division of Cardiology, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
Sarah Tabbutt MD, PhD
Affiliation:
Department of Anesthesia and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA Department of Pediatrics, Division of Cardiology, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
*
Correspondence to: Anne M. Ades MD, Division of Neonatology, 2nd Floor, Main Building, The Children’s Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104. Tel: 215-590-1653; Fax: 215-590-3081; E-mail: ades@email.chop.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Low weight at birth is a risk factor for increased mortality in infants undergoing surgery for congenitally malformed hearts. There has been a trend towards performing surgery in patients early, and for amenable lesions, in a single stage rather than following initial palliative procedures. Our goal was to report on the current incidences of morbidities and mortality in infants born with low weight and undergoing surgery for congenital cardiac disease.

Methods

We made a retrospective review of the data from patients meeting our criterions for entry from July, 2000, through July, 2004. The criterions for inclusion were weight at birth less than or equal to 2500 grams, and congenital cardiac malformations requiring surgery during the initial hospitalization. A criterion for exclusion was isolated persistent patency of the arterial duct. We assessed preoperative, intraoperative, and postoperative variables.

Results

We found a total of 105 patients meeting the criterions for inclusion. The median weight at birth was 2130 grams, and median gestational age was 36 weeks. The most common morbidity identified was infections of the blood stream. Infections, and chronic lung disease, were associated with increased length of stay. Survival overall was 76%. Patients with hypoplastic left heart syndrome, or a variant thereof, had the lowest survival, of 62%. The needs for cardiopulmonary resuscitation, or extracorporeal membrane oxygenation, post-operatively were the only factors identified as independent risk factors for mortality.

Conclusion

Patients undergoing surgery during infancy for congenital cardiac disease who are born with low weight have a higher mortality and morbidity than those born with normal weight.

Keywords

Cardiopulmonary bypasshypoplastic left heart syndromeprematuritylow birth weight
Type
Original Articles
Information
Cardiology in the Young , Volume 20 , Issue 1 , February 2010 , pp. 8 - 17
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Rosenthal, GL, Wilson, PD, Pemutt, T, Boughman, JA, Ferencz, C. Birth weight and cardiovascular malformations: a population based study. Am J Epidemiol 1991; 133: 1273–1281.CrossRefGoogle ScholarPubMed
2.Levy, RJ, Rosenthal, A, Fyler, DC, Nadas, AS. Birthweight of infants with congenital cardiac disease. Am J Dis Child 1978; 132: 249–254.Google Scholar
3.Kramer, HH, Trampisch, HJ, Rammos, S, Giese, A. Birthweight of children with congenital cardiac disease. Eur J Pediatrics 1990; 149: 752–757.CrossRefGoogle Scholar
4.Pawade, A, Waterson, K, Laussen, P, Karl, TR, Mee, RBB. Cardiopulmonary bypass in neonates weighing less than 2.5 kg: analysis of the risk factors for early and late mortality. J Card Surg 1993; 8: 1–8.CrossRefGoogle ScholarPubMed
5.Chang, AC, Hanley, FH, Lock, JE, Castaneda, AR, Wessel, DL. Management and outcome of low birth weight neonates with congenital cardiac disease. J Pediatr 1994; 124: 461–466.CrossRefGoogle Scholar
6.Reddy, VM, McElhinney, DB, Sagrado, T, Parry, AJ, Teitel, DF, Hanley, FL. Results of 102 cases of complete repair of congenital heart defects in patients weighing 700 to 2500 grams. J Thorac Cardiovasc Surg 1999; 117: 324–331.CrossRefGoogle ScholarPubMed
7.Battaglia, FC, Lubchenco, LO. A practical classification of newborn infants by weight and gestational age. J Pediatr 1967; 71: 159–163.CrossRefGoogle ScholarPubMed
8.Walsh, MC, Kliegman, RM. Necrotizing enterocolitis: treatment based on staging criteria. Ped Clinic of N Am 1986; 33: 179–201.CrossRefGoogle ScholarPubMed
9.Jobe, AH, Bancalari, E. Bronchopulmonary dysplasia: NICHD/NHLBI/ORD workshop summary. Am J Respir Crit Care Med 2001; 162: 1723–1729.CrossRefGoogle Scholar
10.Clancy, RR, McGaurn, SA, Wernovsky, G, et al. Preoperative risk-of-death prediction model in heart surgery with deep hypothermic circulatory arrest in the neonate. J Thorac Cardiovasc Surg 2000; 119: 347–357.CrossRefGoogle ScholarPubMed
11.Numa, A, Butt, W, Mee, RBB. Outcome of infants with birthweight 2000 g or less who undergo major cardiac surgery. J Paediatr Child Health 1992; 28: 318–320.CrossRefGoogle ScholarPubMed
12.Dees, E, Lin, H, Cotton, RB, Graham, TP, Dodd, DA. Outcome of preterm infants with congenital cardiac disease. J Pediatr 2000; 137: 653–659.CrossRefGoogle Scholar
13.Reddy, VM, Hanley, FL. Cardiac surgery in very low birth weight infants. Semin Pediatric Surg 2000; 9: 91–95.CrossRefGoogle Scholar
14.Oppido, G, Napoleone, CP, Formigari, R, et al. Outcome of cardiac surgery in low birth weight premature infants. Eur J Cardio-thorac Surg 2004; 24: 44–53.CrossRefGoogle Scholar
15.Rossi, AF, Seiden, HS, Sadeghi, AM, et al. The outcome of cardiac operations in infants weighing two kilograms or less. J Thorac Cardiovasc Surg 1998; 116: 28–35.CrossRefGoogle ScholarPubMed
16.Simchen, MJ, Beiner, ME, Liviathan, NS, et al. Neonatal outcome in growth-restricted versus appropriately grown preterm infants. Am J Perinatol 2000; 17: 187–192.CrossRefGoogle ScholarPubMed
17.Bardin, C, Zelkowitz, P, Papageorgiou, . Outcomes of small-for-gestational age and appropriate-for-gestational age infants born before 27 weeks of gestation. Pediatrics 1997; 100: e4.CrossRefGoogle ScholarPubMed
18.Regev, RH, Lusky, A, Dolfin, T, Litmanovitz, I, Arnon, S, Reichman, B. Excess mortality and morbidity among small-for-gestational-age premature infants: A population based study. J Pediatr 2003; 143: 186–191.CrossRefGoogle ScholarPubMed
19.Aucott, SW, Donohue, PK, Northington, FJ. Increased morbidity in severe early intrauterine growth restriction. J Perinatol 2004; 24: 435–440.CrossRefGoogle ScholarPubMed
20.Abrishamchian, R, Kanhai, D, Zwets, E, Nie, L, Cardarelli, M. Low birth weight or diagnosis, which is higher risk?-a meta-analysis of observational studies. Eur J Cardio-thorac Surg 2006; 30: 700–705.CrossRefGoogle ScholarPubMed
21.Pizarro, C, Davis, DA, Galantowicz, ME, Munro, H, Gidding, SS, Norwood, WI. Stage I palliation for hypoplastic left heart syndrome in low birth weight neonates: can we justify it? Eur J Cardio-thorac Surg 2002; 21: 716–720.CrossRefGoogle Scholar
22.Weinstein, S, Gaynor, JW, Bridges, ND, et al. Early survival of infants weighing 2.5 kilograms or less undergoing first-stage reconstruction for hypoplastic left heart syndrome. Circulation 1999; 100 (Suppl II): II-167–II-170.CrossRefGoogle ScholarPubMed
23.Tabbutt, S, Dominguez, TE, Ravishankar, C, et al. Outcomes after the stage I reconstruction comparing the right ventricular to pulmonary artery conduit with the modified Blalock Taussig shunt. Ann Thorac Surg 2005; 80: 1582–1590.CrossRefGoogle Scholar
24.Beyens, T, Biarent, D, Bouton, JM, et al. Cardiac surgery with extracorporeal circulation in 23 infants weighing 2500 g or less: Short and intermediate term outcome. Eur J Cardio-thorac Surg 1998; 14: 165–172.CrossRefGoogle ScholarPubMed
25.Fanaroff, A, Stoll, B, Wright, L, et al. Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol 2007; 196: 147e1–147e8.CrossRefGoogle ScholarPubMed