Early and late outcomes of surgery for low birth weight infants (LBW <2.5kg) with congenital heart disease

  • Dr Ramesh Parmar, The Children's Hospital at Westmead, Sydney., Australia
  • Dr Bart Koene, Catharina Hospital, Eindhoven., The Netherlands
  • Dr Julian Ayer, The Children's Hospital at Westmead, Sydney., Australia
  • Mr Andrew Cole, The Children's Hospital at Westmead, Sydney., Australia
  • Ms Karen Walker, The Children's Hospital at Westmead, Sydney., Australia
  • A/Prof Gary Sholler, The Children's Hospital at Westmead, Sydney., Australia
  • A/Prof Nadia Badawi, The Children's Hospital at Westmead, Sydney., Australia
  • A/Prof David Winlaw, The Children's Hospital at Westmead, Sydney., Australia

    • Improvements in neonatal care and peri-procedural outcomes have reduced the weight at which cardiac surgery is routinely contemplated. As for normal birth weight infants (NBW, 2.5 – 4kg) quality of outcome measures should include assessments of both physical and neurodevelopmental status however these data are not widely available.

    Methods

    We reviewed our experience between October 2003 and December 2007 and categorised data according to the recent STS database report by Curzon et al. 2008. We examined the role of non technical human factors in a semi-structured interview with attending staff. Finally, we are following the LBW group to determine their cardiologic and neurodevelopmental status.

    Results

    Outcomes for the LBW group (n=41) vs. the NBW (n=260) were compared. 30 day mortality was 22% vs. 3% with weight at surgery being associated with a worse outcome. The most common diagnoses in the LBW group were pulmonary atresia and coarctation. Human factors identified included care and parental fatigue, conflict in perceptions of long term outcome, communication between subspecialty teams involved and experience of the surgeon. Outcomes were rarely influenced by an issue of diagnostic accuracy or technical performance. Developmental assessments suggest significant rates of neurodevelopmental impairment.

    Conclusions

    Low birth weight children continue to represent a significant challenge. Whilst operative mortality is satisfactory and consistent with published reports there is significant early morbidity and many long term problems. Tight integration of sub-specialty groups is required to improve outcomes, and routine neurodevelomental follow up should be mandatory in this group to facilitate early intervention.