Cardiac surgery in the low-birth weight neonate - New approaches

The low-birth weight infant with critical congenital heart defects is likel y to be at a higher risk for postoperative death and complications than the ir normal-sized counterparts. The causes of this increased mortality and mo rbidity are multifactorial: technical issues related to small cardiac struc tures and cannulation for cardiopulmonary bypass, immaturity of other organ systems, decreased nutritional and cardiac reserve, increased risks of ble eding from bypass-related coagulopathy; and abnormal chest wall mechanics a fter median sternotomy. Current experience, however, does not support the p ractice of waiting to obtain an arbitrary weight before surgery in the hope s of improving outcome. A multidisciplinary approach is required to achieve optimal results.