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Cardiac catheterisation in infants weighing less than 2500 grams
Colin J McMahon1, Jack F Price, Jack C Salerno
1Lille Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas 77030, USA. cmcmahon@bcm.tmc.edu
Insights
Cardiac catheterization in low-birth-weight infants (<2500g) carries higher mortality and vascular complication risks. While interventional procedures can be life-saving, diagnostic cardiac catheterization should be deferred for noninvasive methods when possible.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Neonatal Medicine
Background:
- Cardiac catheterization is a crucial diagnostic and therapeutic tool in pediatric cardiology.
- Infants weighing less than 2500 grams represent a vulnerable population with unique physiological challenges.
- Understanding the specific risks and benefits in this low-birth-weight group is essential for optimal patient care.
Purpose of the Study:
- To investigate the indications for cardiac catheterization in infants weighing less than 2500 grams.
- To evaluate the outcomes, including morbidity and mortality, of cardiac catheterization in this low-birth-weight population.
- To compare the results with a cohort of infants weighing greater than 2500 grams.
Main Methods:
- Retrospective analysis of infants weighing less than 2500 grams undergoing cardiac catheterization at Texas Children's Hospital (1993-2001).
- Comparison group of infants weighing greater than 2500 grams of similar age.
- Assessment of procedural indications, interventions performed, and adverse events (mortality, vascular compromise).
Main Results:
- 22 interventional and 12 diagnostic cardiac catheterizations were performed in infants <2500g.
- Mortality rate was 6% in infants <2500g versus 0% in infants >2500g.
- Vascular compromise occurred in 9% of infants <2500g compared to 2% in infants >2500g.
Conclusions:
- Infants weighing less than 2500 grams have a significantly increased risk of mortality and vascular complications following cardiac catheterization.
- Interventional cardiac catheterization can be life-saving in this population.
- Diagnostic cardiac catheterization should be considered for deferral in favor of noninvasive imaging modalities due to increased risks.
Objectives:
To investigate the indications for, and outcome of, cardiac catheterisation in infants weighing less than 2500 g at a single institution over an 8-year period.
Patients And Methods:
We assessed all infants who were less than 2500 g at the time of cardiac catheterisation at Texas Children's Hospital from January 1993 to January 2001. Comparisons of morbidity and mortality were drawn with an equivalent number of infants of similar age weighing greater than 2500 g seen over the same period of time.
Results:
We performed interventional procedures in 22, and diagnostic catheterisations in 12 infants weighing less than 2500 g. Interventions included pulmonary valvoplasty in six patients, balloon angioplasty of critical coarctation in one, aortic valvoplasty in two, septostomy in ten, and coil occlusion of an arteriovenous malformation, redirection of a subclavian venous line, and coil occlusion of a patent arterial duct in one patient each. The median age at catheterisation was 5 days for children less than 2500 g, and 10 days for those above 2500 g. The median weights were 2.3 kg and 3.3 kg, and the median gestational ages were 35 weeks and 38 weeks, for the two respective groups. Of those weighing less than 2500 g, two died (6%), with no deaths occurring in those weighing more than 2500 g. In 3 patients weighing less than 2500 g (9%), there was vascular compromise, one child with bilateral femoral venous obstruction requiring fasciotomy compared, to one in the group weighing greater than 2500 g (2%).
Conclusion:
There is a significantly increased risk of mortality and vascular compromise in infants weighing less than 2500 g. Interventional catheterisation in these infants may be lifesaving, but given the aforementioned risks, diagnostic catheterisation should be deferred if possible in favor of noninvasive modalities.