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Congenital Heart Disease in Low-Birth-Weight Infants: Effects of Small for Gestational Age (SGA) Status and Maturity on Postoperative Outcomes

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Abstract

Few studies have examined the role that small for gestational age (SGA) status plays in postoperative outcomes for low-birth-weight (LBW) infants with congenital heart disease (CHD). This study aimed to examine the effect of SGA status, gestational and chronologic age, and weight on differences in morbidities and mortalities during the immediate postoperative hospitalization period. The charts of infants with CHD weighing less than 2.5 kg who underwent operative repair during the neonatal period between 2004 and 2011 were reviewed. Infants with an isolated patent ductus arteriosus were excluded from the study. Data on hospital morbidities and mortality before discharge were collected. The study identified 136 LBW infants with a diagnosis of CHD. Among the 74 infants who underwent surgery and had complete chart records, the SGA infants had a higher gestational age at birth (36.8 vs. 32.3 weeks; p < 0.0001). The SGA and non-SGA infants did not differ in terms of survival to discharge or immediate postoperative outcomes. A lower weight at surgery was significantly associated with an increased risk of postoperative infection. In contradistinction, an older postnatal age at surgery was associated with an increased risk of preoperative infection (p < 0.0001). Additionally, lower gestational age at birth was associated with home oxygen use, higher tracheostomy rates, and discharge with a gastrostomy tube. Small for gestational age status played no protective role in the outcome for LBW infants after primary surgery for CHD. A weight of 2.4 kg or greater at the time of surgery was associated with lower rates of postoperative infections. Greater duration of time between birth and surgery was associated with a greater risk of preoperative infection. A gestational age of 32 weeks or more at birth was associated with decreased morbidities, which could influence obstetric management.

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Acknowledgments

This publication was supported by NIH/NCRR SC-CTSI grant no. UL1 RR031986. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Division of Neonatal Medicine, Department of Pediatrics, Los Angeles County, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Daniel Wei, Shazia Bhombal & Lisa Paquette

  2. Newborn and Infant Critical Care Unit, University of Southern California Medical Center and Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA

    Daniel Wei, Shazia Bhombal & Lisa Paquette

  3. Clinical and Translational Science Institute, University of Southern California and Children’s Hospital Los Angeles, Los Angeles, CA, USA

    Colleen Azen

  4. Division of Cardiology, Children’s Hospital Los Angeles, Los Angeles, CA, USA

    Shazia Bhombal

  5. Division of Anesthesia and Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, USA

    Laura Hastings

Authors
  1. Daniel Wei
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  2. Colleen Azen
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  3. Shazia Bhombal
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  4. Laura Hastings
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  5. Lisa Paquette
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Correspondence to Lisa Paquette.

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Wei, D., Azen, C., Bhombal, S. et al. Congenital Heart Disease in Low-Birth-Weight Infants: Effects of Small for Gestational Age (SGA) Status and Maturity on Postoperative Outcomes. Pediatr Cardiol 36, 1–7 (2015). https://doi.org/10.1007/s00246-014-0954-y

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  • DOI: https://doi.org/10.1007/s00246-014-0954-y

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