Open heart interventions in premature low- and very-low-birth-weight neonates: risk profile and ethical considerations

Thorac Cardiovasc Surg. 1997 Oct;45(5):238-41. doi: 10.1055/s-2007-1013734.

Abstract

In premature, very-low-birth-weight (VLBW) neonates, complex cardiac malformations can be successfully repaired under conditions of cardiopulmonary bypass. However, due to the immaturity of organ systems, these patients are exposed to a specific risk resulting from noxious effects of extracorporeal circulation, especially on the central nervous system. Two premature neonates with low and very low birth weight of 1160 g and 1650 g, were operated on using cardiopulmonary bypass for severe pulmonary artery stenosis and truncus arteriosus communis type II, respectively. The neonate with pulmonary valve stenosis survived, but at 2-year-follow-up examination motoricity retardation as a result of cerebral immaturity-related changes was evident. The other neonate died suddenly on the fifth postoperative day of a massive intracranial haemorrhage. Due to the fact that the natural history of VLBW children is a priori characterized by a high incidence of major neurological handicaps, open heart surgery may by improving survival chances contribute to an increased incidence of mentally handicapped children.

Publication types

  • Case Reports

MeSH terms

  • Brain Diseases
  • Cardiac Surgical Procedures*
  • Disclosure
  • Ethics, Medical
  • Fatal Outcome
  • Female
  • Heart Defects, Congenital / surgery*
  • Humans
  • Infant, Low Birth Weight*
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases / surgery*
  • Infant, Very Low Birth Weight*
  • Parental Consent
  • Risk Assessment*
  • Risk Factors
  • Therapeutic Human Experimentation