Management and outcome of low birth weight neonates with congenital heart disease,☆☆,

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Abstract

In 100 consecutive neonates with birth weights ≤2500 gm (range, 540 to 2500 gm; median, 2200 gm), major congenital heart disease (excluding patent ductus arteriosus, isolated atrial septal defect, and ventricular septal defect) was diagnosed between January 1987 and January 1991; 46 had ductus-dependent lesions. Of the 100 neonates, 30 had genetic aberrations or significant associated congenital anomalies. The four most common cardiac diagnoses were tetralogy of Fallot with or without pulmonary atresia (n = 16); coarctation of the aorta (n = 12); transposition of the great arteries (n = 11); and common atrioventricular canal (n = 11). The hospital survival rate for the entire group of 100 neonates was 70%. The patients were separated into three groups on the basis of the time of intervention. Group 1 (early intervention) included 62 infants. These neonates (including 31 with ductus-dependent lesions) had surgical or catheter intervention during the initial hospitalization (median age, 9 days), all at weights ≤2500 gm. The hospital survival rate was 81% (50/62); survival rates for palliation (78%, 18/23) and for correction (82%, 32/39) were similar. There were 26 neonates in group 2 (late intervention). These neonates did not have surgical intervention during the initial hospitalization. All were managed medically; survivors were discharged and had surgical procedures later (at a median age of 4.3 months). Six neonates (23%) died during medical management; all 20 survivors returned and had surgical procedures, with 90% survival. Overall survival rate for this group was 69% (18/26). The remaining 12 patients (group 3) had complicating features that precluded intervention; none survived. On the basis of these results, we conclude that early intervention, even with corrective surgery, can be performed in low birth weight neonates with an acceptable mortality rate. Prolonged medical therapy to achieve further weight gain did not appear to improve the survival rate. (J Pediatr 1994;124:461-6)

Section snippets

Patients

The following data were gathered for each infant in the study: (1) pregnancy profile (maternal age and associated medical conditions, presence and status of twin gestation, and length of gestation), (2) delivery history (type of delivery, Apgar scores at 1 and 5 minutes, need for resuscitative measures, date of birth, and birth weight), (3) preoperative status (presence of genetic aberrations, congenital anomalies, or systemic diseases [such as sepsis, renal failure, intraventricular

Pregnancy and delivery

Pregnancy was characterized by young maternal age (≤18 years of age) for 3 patients and older maternal age (≥32 years of age) for 24 patients. Associated maternal medical conditions included hypertension (n = 11), diabetes (n = 4), seizure (n = 1), and collagen vascular disease (n = 1). There were 23 twin gestations.

Of the 100 infants, 34 were delivered by cesarean section, and 66 were delivered vaginally. In 26 neonates the Apgar scores were ≤5 at 1 minute, and in 13 neonates, the scores

DISCUSSION

Although considerable progress has been made in achieving successful repair of heart disease in the neonatal period, application of this strategy of early repair to the LBW neonate has been slowed by the perception that the LBW is a risk factor in surgical intervention. A previous study indicated a high mortality rate in infants who underwent open intracardiac operations in the first 3 months of life,15 whereas we have extended our preference for corrective rather than palliative cardiac

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    From the Departments of Cardiology and Cardiac Surgery, Children's Hospital, and the Departments of Pediatrics, Surgery, and Anesthesia, Harvard Medical School, Boston, Massachusetts

    ☆☆

    Reprint requests: Anthony C. Chang, MD, Cardiac Intensive Care Office, Farley 653, The Children's Hospital, 300 Longwood Ave., Boston, MA 02115.

    0022-3476/94 $3.00 + 0 9/23/51721

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