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The importance of small for gestational age in the risk assessment of infants with critical congenital heart disease

  • Anthony A. Sochet (a1), Mark Ayers (a1), Emilio Quezada (a1), Katherine Braley (a1), Jennifer Leshko (a2), Ernest K. Amankwah (a2), James A. Quintessenza (a3), Jeffrey P. Jacobs (a3) and Gul Dadlani (a1) (a3)...

Abstract

Background

Infants with critical congenital heart disease who require cardiothoracic surgical intervention may have significant post-operative mortality and morbidity. Infants who are small for gestational age <10th percentile with foetal growth restriction may have end-organ dysfunction that may predispose them to increased morbidity or mortality.

Methods

A single-institution retrospective review was performed in 230 infants with congenital heart disease who had cardiothoracic surgical intervention <60 days of age. Pre-, peri-, and post-operative morbidity and mortality markers were collected along with demographics and anthropometric measurements.

Results

There were 230 infants, 57 (23.3%) small for gestational age and 173 (70.6%) appropriate for gestational age. No significant difference was noted in pre-operative markers – gestational age, age at surgery, corrected gestational age, Society for Thoracic Surgeons and European Association for Cardiothoracic Surgery mortality score; or post-operative factors – length of stay, ventilation days, arrhythmias, need for extracorporeal membrane oxygenation, vocal cord dysfunction, hearing loss; or end-organ dysfunction – gastro-intestinal, renal, central nervous system, or genetic. Small for gestational age infants were more likely to have failed vision tests (p = 0.006). Small for gestational age infants were more likely to have increased 30-day (p = 0.005) and discharge mortality (p = 0.035). Small for gestational age infants with normal birth weight (>2500 g) were also at increased risk of 30-day mortality compared with appropriate for gestational age infants (p = 0.045).

Conclusions

Small for gestational age infants with congenital heart disease who undergo cardiothoracic surgery <60 days of age have increased risk of mortality and failed vision screening. Assessment of foetal growth restriction as part of routine pre-operative screening may be beneficial.

Copyright

Corresponding author

Correspondence to: Dr G. Dadlani, MD, Johns Hopkins All Children's Heart Institute, 2nd Floor Outpatient Care Center #206, 601 5th Street South, Saint Petersburg, FL 33701, United States of America. Tel: 727-767-3333; Fax: 727-767-8990; E-mail: gul.dadlani@allkids.org

References

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1.van der Linde, D, Konings, EE, Slager, MA, Witsenburg, M, Helbing, WA, Takkenberg, JJ, Roos-Hesselink, JW. Birth prevalence of congenital heart disease worldwide: A systematic review and meta-analysis. J Am Coll Cardiol 2011; 58: 22412247.
2.Curzon, CL, Milford-Beland, S, Li, JS, et al. Cardiac surgery in infants with low birth weight is associated with increased mortality: analysis of the Society of Thoracic Surgeons Congenital Heart Disease. J Thorac Cardiovasc Surg 2008; 135: 546551.
3.Ades, AM, Dominguez, TE, Nicolson, SC, Gaynor, JW, Spray, TL, Wernovsky, G, Tabbutt, S. Morbidity and mortality after surgery for congenital heart disease in the infant born low weight. Cardiol Young 2010: 817.
4.Fenton, TR. A new growth chart for preterm babies: Babson and Benda's chart updated with recent data and a new format. BMC Pediatr 2003; 3: 13.
5.O'Brien, SM, Clarke, DR, Jacobs, JP, et al. An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg 2009; 138: 11391153.
6.Boo, HA, Harding, JE. The developmental origins of adult disease (Barker) hypothesis. Aust NZ J Obstet Gynaecol 2006; 46: 414.
7.Barker, DJ, Bull, AR, Osmond, C, Simmonds, SJ. Foetal and placental size and risk of hypertension in adult life. Br Med J 1990; 301: 259262.
8.Barker, DJ, Hales, CN, Fall, CH, Osmond, C, Phipps, K, Clark, PM. Type 2 (non-insulin-dependent) diabetes mellitus, hypertension and hyperlipidaemia (syndrome X): relation to reduced fetal growth. Diabetologia 1993; 36: 6267.
9.Newsome, CA, Shiell, AW, Fall, CH, Phillips, DI, Shier, R, Law, CM. Is birth weight related to later glucose and insulin metabolism? – A systematic review. Diabet Med 2003; 20: 339348.
10.Lal, MK, Manktelow, BN, Draper, ES, Field, DJ. Chronic lung disease of prematurity and intrauterine growth retardation: a population-based study. Pediatrics 2003; 111: 483487.
11.Hack, M, Youngstrom, EA, Cartar, L, et al. Behavioral outcomes and evidence of psychopathology among very low birth weight infants at age 20 years. Pediatrics 2004; 114: 932940.
12.Lundgren, EM, Tuvemo, T. Effects of being born small for gestational age on long-term intellectual performance. Best Pract Res Clin Endocrinol Metab 2008; 22: 477488.
13.Berle, , Mykletun, A, Daltveit, AK, Rasmussen, S, Dahl, AA. Outcomes in adulthood for children with foetal growth retardation. A linkage study from the Nord-Trøndelag Health Study (HUNT) and the Medical Birth Registry of Norway. Acta Psychiatr Scand 2006; 113: 501509.
14.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 g. J Thorac Cardiovasc Surg 1999; 117: 324331.
15.Ades, A, Johnson, BA, Berger, S. Management of low birth weight infants with congenital heart disease. Clin Perinatol 2005; 32: 9991015; x-xi.
16.Pinello, L, Manea, S, Visonà Dalla Pozza, L, Mazzarolo, M, Facchin, P. Visual, motor and psychomotor development in small-for-gestational-age preterm infants. J AAPOS 2013; 17: 352356.

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