Neonates with congenital heart disease

Early reparative surgery in neonates and infants with congenital heart dise ase, as opposed to initial palliation and later repair, is now commonplace, Changes to the conduct of cardiopulmonary bypass, timing of surgery and su rgical techniques, and perioperative management substantially have reduced the postoperative mortality and morbidity for these patients. The success o f this strategy of early reparative surgery now has been extended to the pr emature and low-birth-weight newborn, and, along with this, new challenges to postoperative care in the intensive care unit. However, the low mortalit y associated with two-ventricle repairs has not been the experience in newb orns undergoing palliation for single-ventricle defects, in particular, hyp oplastic left heart syndrome. A number of articles regarding management of newborns with single-ventricle defects have been published during the past 12 months, ranging from classification, prenatal diagnosis, treatment optio ns, and predictors of both early and late outcome, which may provide a guid e for patient management. As mortality has declined, there has been an incr eased emphasis on identifying indices that may predict outcome or morbidity both before and after surgery, along with possible strategies to attenuate adverse clinical responses, The inflammatory response to bypass is heighte ned in neonates and infants, and several reports have addressed possible te chniques for attenuating the response. In addition, reports regarding the r isk for necrotizing enterocolitis, the utility of lactate as an index of sy stemic perfusion, potential markers of myocardial and neurologic injury, an d the use of mechanical support of the circulation in newborns with congeni tal heart disease are summarized. Curr Opin Pediatr 2001, 13:220-226 (C) 20 01 Lippincott Williams & Wilkins, Inc.