Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 19
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Axelrod, David M. Chock, Valerie Y. and Reddy, V. Mohan 2016. Management of the Preterm Infant with Congenital Heart Disease. Clinics in Perinatology, Vol. 43, Issue. 1, p. 157.

    Dollat, Camille Vergnat, Mathieu Laux, Daniela Stos, Bertrand Baruteau, Alban Capderou, André Demontoux, Serge Hamann, Michel Mokhfi, Emir Van Aerschot, Isabelle Roussin, Régine Le Bret, Emmanuel Ly, Mohamed Belli, Emre and Lambert, Virginie 2015. Critical Congenital Heart Diseases in Preterm Neonates: Is Early Cardiac Surgery Quite Reasonable?. Pediatric Cardiology, Vol. 36, Issue. 6, p. 1279.

    Santoro, Giuseppe Gaio, Gianpiero Giugno, Luca Capogrosso, Cristina Palladino, Maria Teresa Iacono, Carola Caianiello, Giuseppe and Russo, Maria Giovanna 2015. Ten-years, single-center experience with arterial duct stenting in duct-dependent pulmonary circulation: Early results, learning-curve changes, and mid-term outcome. Catheterization and Cardiovascular Interventions, Vol. 86, Issue. 2, p. 249.

    Srinivasan, Vijay 2015. Improving Outcomes Following Neonatal Cardiac Surgery. Pediatric Critical Care Medicine, Vol. 16, Issue. 5, p. 485.

    Dalton, Heidi J. 2014. How Low Can We Go? The Changing Landscape of Extracorporeal Support in Infants*. Pediatric Critical Care Medicine, Vol. 15, Issue. 1, p. 88.

    Gaynor, J. William Kim, Daniel Seung Arrington, Cammon B. Atz, Andrew M. Bellinger, David C. Burt, Amber A. Ghanayem, Nancy S. Jacobs, Jeffery P. Lee, Teresa M. Lewis, Alan B. Mahle, William T. Marino, Bradley S. Miller, Stephen G. Newburger, Jane W. Pizarro, Christian Ravishankar, Chitra Santani, Avni B. Wilder, Nicole S. Jarvik, Gail P. Mital, Seema and Russell, Mark W. 2014. Validation of association of the apolipoprotein E ε2 allele with neurodevelopmental dysfunction after cardiac surgery in neonates and infants. The Journal of Thoracic and Cardiovascular Surgery, Vol. 148, Issue. 6, p. 2560.

    Kalfa, David Krishnamurthy, Ganga Duchon, Jennifer Najjar, Marc Levasseur, Stéphanie Chai, Paul Chen, Jonathan Quaegebeur, Jan and Bacha, Emile 2014. Outcomes of cardiac surgery in patients weighing <2.5 kg: Affect of patient-dependent and -independent variables. The Journal of Thoracic and Cardiovascular Surgery, Vol. 148, Issue. 6, p. 2499.

    Mehmood, Akhter Ismail, Sameh R. Kabbani, Mohamed S. Abu-Sulaiman, Riyadh M. and Najm, Hani K. 2014. Outcome of low body weight (<2.2kg) infants undergoing cardiac surgery. Journal of the Saudi Heart Association, Vol. 26, Issue. 3, p. 132.

    Padalino, Massimo A. Cavalli, Giacomo De Franceschi, Marco Mancuso, Daniela Maschietto, Nicola Vida, Vladimiro Milanesi, Ornella and Stellin, Giovanni 2014. Surgical Outcomes of Total Anomalous Pulmonary Venous Connection Repair: A 22-Year Experience. Journal of Cardiac Surgery, Vol. 29, Issue. 5, p. 678.

    Kobayashi, Daisuke Sallaam, Salaam Aggarwal, Sanjeev Singh, Harinder R. Turner, Daniel R. Forbes, Thomas J. and Gowda, Srinath T. 2013. Catheterization-based intervention in low birth weight infants less than 2.5 kg with acute and long-term outcome. Catheterization and Cardiovascular Interventions, Vol. 82, Issue. 5, p. 802.

    Krishnamurthy, Ganga Ratner, Veniamin and Bacha, Emile 2013. Neonatal Cardiac Care, a Perspective. Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual, Vol. 16, Issue. 1, p. 21.

    Polito, Angelo Piga, Simone Cogo, Paola E. Corchia, Carlo Carnielli, Virgilio Da Frè, Monica Di Lallo, Domenico Favia, Isabella Gagliardi, Luigi Macagno, Francesco Miniaci, Silvana and Cuttini, Marina 2013. Increased morbidity and mortality in very preterm/VLBW infants with congenital heart disease. Intensive Care Medicine, Vol. 39, Issue. 6, p. 1104.

    Pappas, Athina Shankaran, Seetha Hansen, Nellie I. Bell, Edward F. Stoll, Barbara J. Laptook, Abbot R. Walsh, Michele C. Das, Abhik Bara, Rebecca Hale, Ellen C. Newman, Nancy S. Boghossian, Nansi S. Murray, Jeffrey C. Cotten, C. Michael Adams-Chapman, Ira Hamrick, Shannon and Higgins, Rosemary D. 2012. Outcome of Extremely Preterm Infants (<1,000 g) With Congenital Heart Defects From the National Institute of Child Health and Human Development Neonatal Research Network. Pediatric Cardiology, Vol. 33, Issue. 8, p. 1415.

    Baker-Smith, Carissa M. Neish, Steven R. Klitzner, Thomas S. Beekman, Robert H. Kugler, John D. Martin, Gerard R. Lannon, Carole Jenkins, Kathy J. and Rosenthal, Geoffrey L. 2011. Variation in Postoperative Care following Stage I Palliation for Single-ventricle Patients: A Report from the Joint Council on Congenital Heart Disease National Quality Improvement Collaborative. Congenital Heart Disease, Vol. 6, Issue. 2, p. 116.

    Checchia, Paul A. 2011. Perioperative Mechanical Circulatory Support in Children with Critical Heart Disease. Current Treatment Options in Cardiovascular Medicine, Vol. 13, Issue. 5, p. 414.

    Gelehrter, Sarah Fifer, Carlen G. Armstrong, Aimee Hirsch, Jennifer and Gajarski, Robert 2011. Outcomes of Hypoplastic Left Heart Syndrome in Low-Birth-Weight Patients. Pediatric Cardiology, Vol. 32, Issue. 8, p. 1175.

    Santoro, Giuseppe Gaio, Gianpiero Castaldi, Biagio Palladino, Maria Teresa Iacono, Carola Russo, Maria Giovanna and Calabrò, Raffaele 2011. Arterial duct stenting in low-weight newborns with duct-dependent pulmonary circulation. Catheterization and Cardiovascular Interventions, Vol. 78, Issue. 5, p. 677.

    Seo, Dong-Man Park, Jeong-Jun Yun, Tae-Jin Kim, Young-Hwue Ko, Jae-Kon Park, In-Sook and Jhang, Won Kyoung 2011. The Outcome of Open Heart Surgery for Congenital Heart Disease in Infants With Low Body Weight Less Than 2500 g. Pediatric Cardiology, Vol. 32, Issue. 5, p. 578.

    Williams, Glyn D. and Cohen, Ronald S. 2011. Perioperative management of low birth weight infants for open-heart surgery. Pediatric Anesthesia, Vol. 21, Issue. 5, p. 538.


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

  • Anne M. Ades (a1), Troy E. Dominguez (a2), Susan C. Nicolson (a2), James W. Gaynor (a3), Thomas L. Spray (a3), Gil Wernovsky (a2) (a4) and Sarah Tabbutt (a2) (a4)
  • DOI:
  • Published online: 18 December 2009

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.


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.


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.


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.

Corresponding author
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:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

3.HH Kramer , HJ Trampisch , S Rammos , A Giese . Birthweight of children with congenital cardiac disease. Eur J Pediatrics 1990; 149: 752757.

4.A Pawade , K Waterson , P Laussen , TR Karl , RBB Mee . 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: 18.

5.AC Chang , FH Hanley , JE Lock , AR Castaneda , DL Wessel . Management and outcome of low birth weight neonates with congenital cardiac disease. J Pediatr 1994; 124: 461466.

6.VM Reddy , DB McElhinney , T Sagrado , AJ Parry , DF Teitel , FL Hanley . Results of 102 cases of complete repair of congenital heart defects in patients weighing 700 to 2500 grams. J Thorac Cardiovasc Surg 1999; 117: 324331.

7.FC Battaglia , LO Lubchenco . A practical classification of newborn infants by weight and gestational age. J Pediatr 1967; 71: 159163.

8.MC Walsh , RM Kliegman . Necrotizing enterocolitis: treatment based on staging criteria. Ped Clinic of N Am 1986; 33: 179201.

10.RR Clancy , SA McGaurn , G Wernovsky , Preoperative risk-of-death prediction model in heart surgery with deep hypothermic circulatory arrest in the neonate. J Thorac Cardiovasc Surg 2000; 119: 347357.

11.A Numa , W Butt , RBB Mee . Outcome of infants with birthweight 2000 g or less who undergo major cardiac surgery. J Paediatr Child Health 1992; 28: 318320.

12.E Dees , H Lin , RB Cotton , TP Graham , DA Dodd . Outcome of preterm infants with congenital cardiac disease. J Pediatr 2000; 137: 653659.

13.VM Reddy , FL Hanley . Cardiac surgery in very low birth weight infants. Semin Pediatric Surg 2000; 9: 9195.

15.AF Rossi , HS Seiden , AM Sadeghi , The outcome of cardiac operations in infants weighing two kilograms or less. J Thorac Cardiovasc Surg 1998; 116: 2835.

16.MJ Simchen , ME Beiner , NS Liviathan , Neonatal outcome in growth-restricted versus appropriately grown preterm infants. Am J Perinatol 2000; 17: 187192.

17.C Bardin , P Zelkowitz , Papageorgiou. Outcomes of small-for-gestational age and appropriate-for-gestational age infants born before 27 weeks of gestation. Pediatrics 1997; 100: e4.

18.RH Regev , A Lusky , T Dolfin , I Litmanovitz , S Arnon , B Reichman . Excess mortality and morbidity among small-for-gestational-age premature infants: A population based study. J Pediatr 2003; 143: 186191.

19.SW Aucott , PK Donohue , FJ Northington . Increased morbidity in severe early intrauterine growth restriction. J Perinatol 2004; 24: 435440.

20.R Abrishamchian , D Kanhai , E Zwets , L Nie , M Cardarelli . Low birth weight or diagnosis, which is higher risk?-a meta-analysis of observational studies. Eur J Cardio-thorac Surg 2006; 30: 700705.

21.C Pizarro , DA Davis , ME Galantowicz , H Munro , SS Gidding , WI Norwood . Stage I palliation for hypoplastic left heart syndrome in low birth weight neonates: can we justify it? Eur J Cardio-thorac Surg 2002; 21: 716720.

22.S Weinstein , JW Gaynor , ND Bridges , 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-167II-170.

23.S Tabbutt , TE Dominguez , C Ravishankar , 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: 15821590.

24.T Beyens , D Biarent , JM Bouton , 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: 165172.

25.A Fanaroff , B Stoll , L Wright , Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol 2007; 196: 147e1147e8.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
  • URL: /core/journals/cardiology-in-the-young
Please enter your name
Please enter a valid email address
Who would you like to send this to? *