![]() 18 Another nationwide study revealed that the infant mortality rate due to CHD increased linearly with a decreasing gestational age <39 weeks. 17– 21 A study involving 971 neonates with critical CHD revealed that those born at 37 to 38 weeks’ gestation had 2.3-fold greater adjusted odds of in-hospital mortality when compared with a reference group born at 39 to 40 weeks. The authors of various studies who have investigated the association between gestational age and mortality have suggested that mortality is increased for any gestational age other than 39 to 40 weeks. 16 Gestational age is an independent risk factor for morbidity and mortality. When there is no prenatal care or when there is a discrepancy between obstetrical dating estimate and infant examination at the time of birth, the Ballard examination can provide a postnatal gestational age estimate. Gestational age dating is determined by obstetrical ultrasound or last menstrual period. Please refer to the article in this supplement on Surgical Readiness for an extensive discussion of these issues with regard to outcomes and timing of cardiovascular surgery. These may include prematurity, infection, congenital anomalies, and genetic abnormalities. 8– 15 However, other factors that may impact the prognosis should be evaluated and managed before proceeding to surgery. Therefore, early surgery can be performed, even in patients with a weight of <2.5 kg. Although many studies have revealed higher mortality in patients with low birth weight (<2.5 kg), 5– 7 it has been found that delaying surgery to achieve adequate weight has more detrimental effects on the hemodynamics of the heart, compared with the benefit. Various studies have assessed the correlation between weight and post-operative morbidity and mortality to determine the targeted weight for surgical intervention. The weight of the neonate at the time of cardiac surgery is an important predictor of morbidity and mortality.
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