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Author(s): Julien Heinrich Park[sup.1] , Martin Weissensteiner[sup.2] , Oliver Wagner[sup.2] , Yoshinao Wada[sup.3] , Stephan Rust[sup.1] , Janine Reunert[sup.1] , Thorsten Marquardt[sup.1] Author Affiliations: (1) Klinik und Poliklinik für Kinder- [...]

Abstract: Objective: Because of their poor clinical status, infants may require surgery for congenital heart disease regardless of weight or prematurity. This retrospective review describes a single-centre experience with open-heart surgery in low-weight infants. Methods: From November 1997 to December 2006, 411 open-heart surgery procedures were performed in neonates. This included 46 consecutive infants weighing less than 2500g, who underwent cardiopulmonary bypass for correction of congenital heart defects (n =34) or Norwood stage I palliation of hypoplastic left heart syndrome (HLHS) (n =12). In the low-weight group were 23 males and 23 females with a median age of 10 days and a median weight of 2.26kg (range: 1.28–2.49kg). Results: Early mortality was 8.2% in patients weighing more than 2.5kg and 13% in the low-weight group. Within the low-weight group, weight at surgery, history of prematurity and prevalence of additional extracardiac malformations did not influence early mortality. At a median follow-up time of 32 months overall mortality was 21%. Thirty-four patients had a neurological follow-up examination 30 months postoperatively. Of the 34 survivors, 11 showed neurological deficits. Conclusions: In our patient population, early mortality was higher for infants weighing less than 2.5kg. However, within the low-weight group, lower weight at surgery or history of prematurity was not associated with a higher mortality or bad neurological outcome. [Copyright &y& Elsevier]

This prospective study investigates whether amino terminal proB-type natriuretic peptide (NT-proBNP) levels are elevated in neonates with congenital heart defect (CHD). NT-proBNP levels in the umbilical cord blood of 60 neonates with prenatally diagnosed CHD, in the cord blood of 200 control subjects, and in the plasma of the respective mothers were analyzed using an automated enzyme immunoassay. NT-proBNP concentrations in the cord blood of the CHD group were significantly elevated compared with controls [median (range): 158 pg/mL (378-3631 pg/mL) and 626 pg/mL (153-2518 pg/mL); p value <0.001]. The NT-proBNP concentrations of the newborns and their mothers did correlate neither in the CHD nor in the control group. In 54 patients with CHD, NT-proBNP levels were measured on the median 5th day of life. They showed a significant increase (median 1665 pg/mL and 19222 pg/mL; p < 0.001). NT-proBNP levels in the cord blood of neonates with CHD are significantly elevated and show a marked increase in the first week of life. Furthermore, this study confirms previously published reference intervals of NT-proBNP in the cord blood of healthy neonates as well as the finding that there is no exchange of NT-proBNP across the placenta.