OPEN-HEART INTERVENTIONS IN PREMATURE LOW-BIRTH-WEIGHT AND VERY-LOW-BIRTH-WEIGHT NEONATES - RISK PROFILE AND ETHICAL CONSIDERATIONS

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