Background
Infants with critical congenital heart disease who require cardiothoracic surgical intervention may have significant postoperative mortality and morbidity. Infants who are small for gestational age (SGA) <10th percentile with foetal growth restriction may have end-organ dysfunction that may predispose them to increased morbidity or mortality.
Methods
A single institution retrospective review was performed in 230 infant with congenital heart disease who had cardiothoracic surgical intervention <60 days of age. Pre-, peri-, and post-operative morbidity and mortality markers were collected along with demographics and anthropometric measurements.
Results
There were 230 infants 57 (23.3%) small for gestational age and 173 (70.6%) appropriate for gestational age (AGA). No significant difference was noted in pre-operative markers - gestational age, age at surgery, corrected gestational age, Society for Thoracic Surgeons and –European Association for Cardiothoracic Surgery mortality score; or post-operative factors - length of stay, ventilation days, arrhythmias, need for extracorporeal membrane oxygenation, vocal cord dysfunction, hearing loss; or end-organ dysfunction - gastro-intestinal, renal, central nervous system, or genetic. Small for gestational age infants were more likely to have failed vision tests (p=0.006). Small for gestational age infants were more likely to have increased 30-day (p=0.005) and discharge mortality (p=0.035). Small for gestational age infants with normal birth weight (>2500 grams) were also at increased risk of 30-day mortality compared to AGA infants (p=0.045).
Conclusions
Small for gestational age infants with congenital heart disease who undergo cardiothoracic surgery <60days of age have increased risk of mortality and failed vision screening. Assessment of foetal growth restriction as part of routine preoperative screening may be beneficial.
Input from diverse stakeholders is critical to the process of designing healthcare interventions. This study applied a novel mixed-methods, stakeholder-engaged approach to co-design a psychosocial intervention for mothers expecting a baby with congenital heart disease (CHD) and their partners to promote family wellbeing. The research team included parents and clinicians from 8 health systems. Participants were 41 diverse parents of children with prenatally diagnosed CHD across the 8 health systems. Qualitative data were collected through online crowdsourcing and quantitative data were collected through electronic surveys to inform intervention co-design. Phases of intervention co-design were: (I) Engage stakeholders in selection of intervention goals/outcomes; (II) Engage stakeholders in selection of intervention elements; (III) Obtain stakeholder input to increase intervention uptake/utility; (IV) Obtain stakeholder input on aspects of intervention design; and (V) Obtain stakeholder input on selection of outcome measures. Parent participants anticipated the resulting intervention, HEARTPrep, would be acceptable, useful, and feasible for parents expecting a baby with CHD. This model of intervention co-design could be used for the development of healthcare interventions across chronic diseases.
Using current recommended methods, AoD will be missed in overweight and obese patients and overdiagnosed in underweight patients. For children of normal weight, a Z-score based on BSA may be reliable. As obesity rates increase, weight-independent Z-scores must be developed.
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