Early outcomes of 203 neonates with low birth weight undergoing cardiac surgery and analysis of death causes_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LU Chao , YU Lina , WEI Jingfeng , LIANG Jiexian ,  ZHUANG Jian ,  WANG Sheng

Guangdong Cardiovascular Institute, Guangdong Medical Science Academy, Guangdong General Hospital, Guangzhou, 510080, P.R.China;

Corresponding?author：

ZHUANG Jian, Email: zhuangjian5413@tom.com; WANG Sheng, Email: shengwang_gz@163.com

Keywords：

Neonates; low birth weight; congenital heart surgery; early outcome; death cause

DOI：

10.7507/1007-4848.201712039

Video：

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Objective To analyze the early outcomes of 203 neonates with low birth weight (<2 500 g) undergoing cardiac surgery, and to analyze the causes of death during hospitalization.Methods From June 2003 to June 2017, medical records of 203 neonates with low birth weight undergoing congenital heart surgery in Guangdong General Hospital were reviewed retrospectively. There were 124 males and 79 females, including 151 premature infants. The average birth weight was 1 719±515 g, the average age at operation was 32.7±20.2 d and the average weight at operation was 1 994±486 g. The causes of death during hospitalization (including neonates given up on treatments) were analyzed.Results Totally 103 patients had pneumonia, 98 patients needed mechanical ventilation to support breathing and 26 patients needed emergency operation before operation. All patients undergoing congenital heart surgery were treated with general anesthesia with tracheal intubation, including 107 patients under non cardiopulmonary bypass (CPB) and 96 patients under CPB with a mean CPB time of 96.5±71.7 min and a mean aorta cross-clamp time of 51.8±45.5 min. The average postoperative mechanical ventilation time was 9.1±21.5 d and the average postoperative length of stay was 26.7±19.3 d. The major postoperative complications included pneumonia, anemia, atelectasis, septicemia, intrapleural hemorrhage, diaphragm paralysis and cardiac dysfunction. Twenty-nine patients died during hospitalization and the overall mortality rate was 14.3%. Four patients died in the operation room, 14 patients died 72 hours after operation and 2 patients were given up. The main causes of hospitalized death were low cardiac output syndrome, severe infection, disseminated intravascular coagulation disorder, acute renal failure and pulmonary hypertension crisis.Conclusion Overall, early cardiac surgery for low birth weight neonates is safe and effective. The difficulty of the cardiac surgery is the key to the prognosis. Strengthening perioperative management can improve the quality of operation and reduce the risk of mortality and morbidity during hospitalization.

Citation： LU Chao, YU Lina, WEI Jingfeng, LIANG Jiexian, ZHUANG Jian, WANG Sheng. Early outcomes of 203 neonates with low birth weight undergoing cardiac surgery and analysis of death causes. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(11): 971-976. doi: 10.7507/1007-4848.201712039 Copy

1.	Rosenberg A. The IUGR newborn. Semin Perinatol, 2008, 32(3): 219-224.
2.	Reddy VM. Cardiac surgery for premature and low birth weight neonates. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2001, 4: 271-276.
3.	Ades AM, Dominguez TE, Nicolson SC, et al. Morbidity and mortality after surgery for congenital cardiac disease in the infant born with low weight. Cardiol Young, 2010, 20(1): 8-17.
4.	Seo DM, Park JJ, Yun TJ, et al. The outcome of open heart surgery for congenital heart disease in infants with low body weight less than 2500 g. Pediatr Cardiol, 2011, 32(5): 578-584.
5.	Kramer HH, Trampisch HJ, Rammos S, et al. Birth weight of children with congenital heart disease. Eur J Pediatr, 1990, 149(11): 752-757.
6.	Rosenthal GL, Wilson PD, Permutt T, et al. Birth weight and cardiovascular malformations: a population-based study. The Baltimore-Washington Infant Study. Am J Epidemiol, 1991, 133(12): 1273-1281.
7.	Tanner K, Sabrine N, Wren C. Cardiovascular malformations among preterm infants. Pediatrics, 2005, 116(6): e833-e838.
8.	Williams GD, Cohen RS. Perioperative management of low birth weight infants for open-heart surgery. Paediatr Anaesth, 2011, 21(5): 538-553.
9.	Azakie A, Johnson NC, Anagnostopoulos PV, et al. Cardiac surgery in low birth weight infants: current outcomes. Interact Cardiovasc Thorac Surg, 2011, 12(3): 409-413.
10.	曾嶸, 莊建, 陳寄梅, 等. 低出生體重兒及早產兒心臟手術的早期療效分析. 中國胸心血管外科臨床雜志, 2012, 19(3): 227-231.
11.	陳浩, 徐志偉, 王浩, 等. 低體質量新生兒先天性心臟病外科手術的危險因素. 中華胸心血管外科雜志, 2017, 33(5): 271-275.
12.	楊盛春, 陳欣欣, 崔虎軍, 等. 24 例低體重危重先天性心臟病患兒的外科治療. 中華胸心血管外科雜志, 2012, 28(11): 680-682.
13.	Ades A, Johnson BA, Berger S. Management of low birth weight infants with congenital heart disease. Clin Perinatol, 2005, 32(4): 999-1015.
14.	Lechner E, Wiesinger-Eidenberger G, Weissensteiner M, et al. Open-heart surgery in premature and low-birth-weight infants--a single-centre experience. Eur J Cardiothorac Surg, 2009, 36(6): 986-991.
15.	Padley JR, Cole AD, Pye VE, et al. Five-year analysis of operative mortality and neonatal outcomes in congenital heart disease. Heart Lung Circ, 2011, 20(7): 460-467.
16.	Kalfa D, Krishnamurthy G, Duchon J, et al. Outcomes of cardiac surgery in patients weighing. J Thorac Cardiovasc Surg, 2014, 148(6): 2499-2506.
17.	Kabra NS, Schmidt B, Roberts RS, et al. Neurosensory impairment after surgical closure of patent ductus arteriosus in extremely low birth weight infants: results from the Trial of Indomethacin Prophylaxis in Preterms. J Pediatr, 2007, 150(3): 229-234.
18.	Naik-Mathuria B, Chang S, Fitch ME, et al. Patent ductus arteriosus ligation in neonates: preoperative predictors of poor postoperative outcomes. J Pediatr Surg, 2008, 43(6): 1100-1105.
19.	Alexander F, Chiu L, Kroh M, et al. Analysis of outcome in 298 extremely low-birth-weight infants with patent ductus arteriosus. J Pediatr Surg, 2009, 44(1): 112-117.
20.	Clapp DW. Developmental regulation of the immune system. Semin Perinatol, 2006, 30(2): 69-72.
21.	Kettner SC, Pollak A, Zimpfer M, et al. Heparinase-modified thrombelastography in term and preterm neonates. Anesth Analg, 2004, 98(6): 1650-1652.
22.	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 Database. J Thorac Cardiovasc Surg, 2008, 135(3): 546-551.

1. Rosenberg A. The IUGR newborn. Semin Perinatol, 2008, 32(3): 219-224.
2. Reddy VM. Cardiac surgery for premature and low birth weight neonates. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2001, 4: 271-276.
3. Ades AM, Dominguez TE, Nicolson SC, et al. Morbidity and mortality after surgery for congenital cardiac disease in the infant born with low weight. Cardiol Young, 2010, 20(1): 8-17.
4. Seo DM, Park JJ, Yun TJ, et al. The outcome of open heart surgery for congenital heart disease in infants with low body weight less than 2500 g. Pediatr Cardiol, 2011, 32(5): 578-584.
5. Kramer HH, Trampisch HJ, Rammos S, et al. Birth weight of children with congenital heart disease. Eur J Pediatr, 1990, 149(11): 752-757.
6. Rosenthal GL, Wilson PD, Permutt T, et al. Birth weight and cardiovascular malformations: a population-based study. The Baltimore-Washington Infant Study. Am J Epidemiol, 1991, 133(12): 1273-1281.
7. Tanner K, Sabrine N, Wren C. Cardiovascular malformations among preterm infants. Pediatrics, 2005, 116(6): e833-e838.
8. Williams GD, Cohen RS. Perioperative management of low birth weight infants for open-heart surgery. Paediatr Anaesth, 2011, 21(5): 538-553.
9. Azakie A, Johnson NC, Anagnostopoulos PV, et al. Cardiac surgery in low birth weight infants: current outcomes. Interact Cardiovasc Thorac Surg, 2011, 12(3): 409-413.
10. 曾嶸, 莊建, 陳寄梅, 等. 低出生體重兒及早產兒心臟手術的早期療效分析. 中國胸心血管外科臨床雜志, 2012, 19(3): 227-231.
11. 陳浩, 徐志偉, 王浩, 等. 低體質量新生兒先天性心臟病外科手術的危險因素. 中華胸心血管外科雜志, 2017, 33(5): 271-275.
12. 楊盛春, 陳欣欣, 崔虎軍, 等. 24 例低體重危重先天性心臟病患兒的外科治療. 中華胸心血管外科雜志, 2012, 28(11): 680-682.
13. Ades A, Johnson BA, Berger S. Management of low birth weight infants with congenital heart disease. Clin Perinatol, 2005, 32(4): 999-1015.
14. Lechner E, Wiesinger-Eidenberger G, Weissensteiner M, et al. Open-heart surgery in premature and low-birth-weight infants--a single-centre experience. Eur J Cardiothorac Surg, 2009, 36(6): 986-991.
15. Padley JR, Cole AD, Pye VE, et al. Five-year analysis of operative mortality and neonatal outcomes in congenital heart disease. Heart Lung Circ, 2011, 20(7): 460-467.
16. Kalfa D, Krishnamurthy G, Duchon J, et al. Outcomes of cardiac surgery in patients weighing. J Thorac Cardiovasc Surg, 2014, 148(6): 2499-2506.
17. Kabra NS, Schmidt B, Roberts RS, et al. Neurosensory impairment after surgical closure of patent ductus arteriosus in extremely low birth weight infants: results from the Trial of Indomethacin Prophylaxis in Preterms. J Pediatr, 2007, 150(3): 229-234.
18. Naik-Mathuria B, Chang S, Fitch ME, et al. Patent ductus arteriosus ligation in neonates: preoperative predictors of poor postoperative outcomes. J Pediatr Surg, 2008, 43(6): 1100-1105.
19. Alexander F, Chiu L, Kroh M, et al. Analysis of outcome in 298 extremely low-birth-weight infants with patent ductus arteriosus. J Pediatr Surg, 2009, 44(1): 112-117.
20. Clapp DW. Developmental regulation of the immune system. Semin Perinatol, 2006, 30(2): 69-72.
21. Kettner SC, Pollak A, Zimpfer M, et al. Heparinase-modified thrombelastography in term and preterm neonates. Anesth Analg, 2004, 98(6): 1650-1652.
22. 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 Database. J Thorac Cardiovasc Surg, 2008, 135(3): 546-551.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Early outcomes of 203 neonates with low birth weight undergoing cardiac surgery and analysis of death causes

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