Management of low birth weight infants with congenital heart disease

LBW infants with CHD have a higher mortality risk and likely a higher morbidity risk than their preterm or appropriate for gestational age counterparts without CHD and term counterparts with CHD. As our understanding of the pathophysiology and treatment of the diseases associated with prematurity and growth restriction improves, the outcomes for these infants should continue to improve. In addition, as more of these infants survive and are referred for surgery, operative techniques and strategies are likely to continue to improve. At this time, there is not adequate evidence that mortality is improved by delaying surgery for weight gain or performing palliative operations initially. Currently, at the Children's Hospital of Philadelphia, patients who weigh less than 1000 g are operated on as soon as they are stabilized from their perinatal events and reparative surgeries are generally done, except in extenuating circumstances (eg, associated anomalies also requiring surgery, continued pulmonary instability thought to be mainly attributable to prematurity). Given the challenging physiology in this population, optimal management includes early referral to a tertiary or quaternary facility and a multidisciplinary team approach consisting of cardiologists, neonatologists, surgeons, nurses, perfusionists, and anesthesiologists.