Neonatal Repair of Tetralogy of Fallot

Symptomatic neonatal Tetralogy of Fallot: Repair or Shunt?

Kanter et al. Ann Thorac Surgery 2010;89:858-63

Neonatal repair of TOF results in improved pulmonary artery development without increased need for reintervention.

Kolcz J & Pizarro, C. Eur J Cardio-thorac Surg 2005;394-99

Long-term results in right ventricular outflow tract reconstruction in neonatal cardiac surgery: Options and outcomes.

Kaza AK, et al. 2009;138:911-16

Poor outcome was reported from Boston Children's Hospital in 1991: 14 symptomatic babies had complete repair of TOF at less than 30 days. 4/14 (28.6%) died (JTCVS 1991;101:126-37).

Better results from Michigan. (Hennein HA et al. JTCVS 1995:109:332-44). n-30, No hospital death. 25% reoperation rate in mean f-up of 15 months.

Updated data from Michigan in 2000 (Hirsch JC et al. 2000;232:508-14), report 61% freedom from reoperation at 5 yrs.

Melbourne BT shunt experience.

Twelve year experience with the modified Blalock-Taussig shunt in neonates. Eur J Thorac Cardiovasc Surg 1992;6:586-9. Nearly 100 neonates with 1 death in 10 years. Find the paper and read it.

Outcome: LBW babies with CHD

Outcome Analysis of Major Cardiac Operations in Low Birthweight Neonates.

Bove et al. Ann Thoracic Surg 2004;78:181-7.

1995-2003; Belgium, Less than 2.5 kg.

n=49 (Corrective Surgery 31, Palliative Surgery 18)

Weight: 1.3 - 2.5 (mean = 2.19) kg

Age at operation: 1 - 90 (mean = 15.2) days

Lesions: VSD 10, TOF 8, CoA 8, TGA 7, Single V 4, PA-IVS 4, IAA 3, TAPVR 3, CAVSD 2.

Overall mortality: 18% (4/31 & 5/18)

Mean f-up: 2.8 yrs

Survival: 87% for corrective surgery gp. 54% for palliative surgery gp.

Postop. Neonatal Nutrition

Nutrition in Clinical Practice 2009;24:242-9.

Nutrition Support After Neonatal Cardiac Surgery
Joyce L. Owens, RD,CD, CANS
Ndidiamaka Musa, MD
Medical College of Wisconsin, Pediatrics: Critical Care, Milwaukee, Wisconsin.

Abstract
Congenital heart disease is the most common birth defect in the United States, with an estimated frequency of approximately 12–14 of 1000 live births per year. Neonates with congenital heart disease often need palliative or corrective surgery requiring cardiopulmonary bypass during the first weeks of life. The neonate undergoing cardiopulmonary bypass surgery experiences a more profound metabolic response to stress than that seen in older children and adults undergoing surgery. However, compared with older children and adults, the neonate has less metabolic reserves and is extremely vulnerable to the negative metabolic impact induced by stress, which can lead to suboptimal wound healing and growth failure. There are complications associated with the metabolic derangements of neonatal surgery requiring cardiopulmonary bypass, including but not limited to acute renal failure, chylothorax, and neurological dysfunction. This article discusses the importance of nutrition and metabolic support for the neonate undergoing cardiopulmonary bypass and the immediate postoperative nutrition needs of such a patient. Also, this article uses a case study to examine the feeding methodology used at one particular institution after neonatal cardiac surgery. The purpose of the case study is to provide an illustration of the many factors and obstacles that clinicians often face in the provision and timing of nutrition support.