Low birth weight or diagnosis, which is a higher risk? — a meta-analysis of observational studies

Abstract

Published experience with surgical treatment of newborns with low birth weight and congenital heart disease is circumscribed to isolated single case reports and a limited number of case-series. To better assess the risks of early surgical treatment and its relationship to weight and diagnosis we performed a meta-analysis of observational studies, limited to those from which data on individual patients could be extrapolated. A search on the subject in peer-reviewed journals published between 1993 and 2004 limited the number of studies, according to our restrictive criteria, to six articles. Our own series of 37 patients was added to the body of data collected in the meta-analyses. Data on 356 individually identified patients was extracted from the articles. Median weight was 2.05 kg (range 1.1-2.5) and median gestational age was 34.2 weeks (range 26-42). Overall surgical survival was 83.9% but survival was higher when a full repair was done (86.1%). According to our analysis, diagnosis was the most significant predictor of mortality (p = 0.001). Other important predictors were the presence of a surgical complication (p = 0.01), palliative surgery (p = 0.03) and the need for reoperation during the same admission (p = 0.03). We concluded that similarly to larger newborns, diagnosis in this group of patients is the most important predictor of mortality. Independently of patient's weight a full anatomic and physiologic repair is justified in most cases.

Perventricular device closure of isolated muscular ventricular septal defect in infants: A single centre experience

“…Lower body weight was associated with higher hospital mortality in a meta-analysis of seven series. 31 Risk correlation of lower weight has similar implication during percutaneous intervention, as well. Holzer et al concluded that low body weight, at the time of procedure, significantly correlates with an increased risk of procedure as well as device-related complications ( p e 0.007).…”

“…32 Holzer et al reported arrhythmic events in 20% including conduction blocks (RBBB) in 2.6%. 31 Serraf et al reported 3% incidence of CHB in 130 children after surgical closure of isolated multiple ventricular septal defects. 2 Though not observed in this series, other procedure-related difficulties or complications associated with perventricular device closure (Table 2) include, device embolization, 16 LV pseudoaneurysm, 17 and unexpanded RV disc protruding into pericardium.…”

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

“…A recent metanalysis has also demonstrated that diagnosis is a predictor of mortality in infants who undergo surgery when weighing less than 2500 grams. 20 Mortalities of 45 to 51% have been reported in such infants undergoing staged reconstruction for hypoplastic left heart syndrome and its variants. 21,22 The mortality in our population with these lesions was 38.3%, thus paralleling the historical trend of improving outcomes in infants with hypoplastic left heart syndrome.…”

Perioperative management of low birth weight infants for open‐heart surgery

“…Mortality has been associated with high RACHS‐1 and Aristotle preoperative risk assessment scores (13,132,133) and certain cardiac diagnoses (133). A meta‐analysis demonstrated that first‐stage reconstruction for hypoplastic left heart syndrome (HLHS) was a predictor of mortality in LBW infants (134), and mortality rates of 38% to 67% are reported (22,131,135,136). Hospital survival for Stanford infants who underwent this procedure (43%) was much lower than the institution’s reported survival (93%) for the overall HLHS population (137).…”

“…This infrastructure may be most efficiently supported in high‐volume centers in countries with sophisticated healthcare systems. The perioperative management described may not easily apply to populations and/or healthcare systems elsewhere (134,139).…”