Open heart interventions in premature low- and very-low-birth-weight neonates: risk profile and ethical considerations.
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.
Borowski
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A
Department of Cardiovascular Surgery, University of Cologne, Germany.
Schickendantz
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S
Mennicken
U
U
Korb
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H
D001927:Brain Diseases; D006348:Cardiac Surgical Procedures; D030881:Disclosure; D004992:Ethics, Medical; D017809:Fatal Outcome; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000601:surgery*; D019102:Infant, Very Low Birth Weight; D033282:Parental Consent; D018570:Risk Assessment; D012307:Risk Factors; D036302:Therapeutic Human Experimentation