title: The importance of small for gestational age in the risk assessment of infants with critical congenital heart disease.
abstract: BACKGROUND
  Infants with critical congenital heart disease who require cardiothoracic surgical intervention may have significant post-operative mortality and morbidity. Infants who are small for gestational age <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 infants 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. 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 g) were also at increased risk of 30-day mortality compared with appropriate for gestational age infants (p = 0.045).
  
  
  CONCLUSIONS
  Small for gestational age infants with congenital heart disease who undergo cardiothoracic surgery <60 days of age have increased risk of mortality and failed vision screening. Assessment of foetal growth restriction as part of routine pre-operative screening may be beneficial.
authors.affiliation: 1 Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, United States of America.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Sochet
authors.affiliation: 1 Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, United States of America.
authors.forename: Mark
authors.initials: M
authors.lastname: Ayers
authors.affiliation: 1 Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, United States of America.
authors.forename: Emilio
authors.initials: E
authors.lastname: Quezada
authors.affiliation: 1 Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, United States of America.
authors.forename: Katherine
authors.initials: K
authors.lastname: Braley
authors.affiliation: 2 Clinical and Translational Research Office, Johns Hopkins All Children's Hospital, Florida, United States of America.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Leshko
authors.affiliation: 2 Clinical and Translational Research Office, Johns Hopkins All Children's Hospital, Florida, United States of America.
authors.forename: Ernest K
authors.initials: EK
authors.lastname: Amankwah
authors.affiliation: 3 Johns Hopkins All Childrens Heart Institute, All Children's Hospital, St Petersburg, Florida, United States of America.
authors.forename: James A
authors.initials: JA
authors.lastname: Quintessenza
authors.affiliation: 3 Johns Hopkins All Childrens Heart Institute, All Children's Hospital, St Petersburg, Florida, United States of America.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.affiliation: 1 Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, United States of America.
authors.forename: Gul
authors.initials: G
authors.lastname: Dadlani
mesh_terms: D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment