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Neonatal cardiac surgery in low resource settings: implications of birth weight
  1. Chamith Mendis Gunasekara1,
  2. Katie Moynihan2,
  3. Abish Sudhakar1,
  4. Gopalraj Sumangala Sunil1,
  5. Brijesh P Kotayil1,
  6. Praveen Reddy Bayya1,
  7. Raman Krishna Kumar1
  1. 1Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
  2. 2Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Raman Krishna Kumar, Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India; kumar_rk{at}


Objective We sought to evaluate the association between low birth weight (LBW) and outcomes following neonatal cardiac surgery in a low-income and middle-income country setting where LBW prevalence is high and its impact on surgical outcomes is undefined.

Design Single-centre retrospective cohort study.

Setting Referral paediatric hospital in Southern India

Patients All neonatal cardiac surgical cases between January 2011 and December 2018. LBW was defined as <2.5 kg.

Main outcome measures Patient demographics, corrective versus palliative surgery and postoperative outcomes were collected from the institutional database which undergoes regular audit as part of International Quality Improvement Collaborative for Congenital Heart Disease. In-hospital mortality was the primary outcome measure.

Results Of 569 neonatal cardiac operations, 123 (21.6%) had LBW (mean: 2.2±0.3 kg); 18.7% <2 kg and 21.1% were preterm (<37 weeks). Surgery type (corrective vs palliative) or non-cardiac anomalies were not associated with birth weight. Birth weight did not correlate with ICU length of stay (LOS) and mechanical ventilation but was lower in those with postoperative sepsis. Overall in-hospital mortality was 7.0%; LBW neonates had higher mortality (OR 2.16, 95% CI 1.09 to 4.29, p=0.025). Multivariable analyses revealed birth weight (OR per 100 g decrease in weight: 1.12; 95% CI 1.03 to 1.22), age at surgery (OR per day increase in age of 0.93; 95% CI 0.87 to 0.99) and palliative intervention (OR 4.46 (95% CI 1.91 to 10.44) as independent predictors of in-hospital mortality.

Conclusion LBW adversely impacts in-hospital mortality outcomes following neonatal cardiac surgery in a resource-limited setting without increase in ICU or hospital LOS.

  • cardiac surgery
  • outcomes research
  • neonatology
  • intensive care
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  • Contributors CMG collected the data and wrote the initial draft of the manuscript. KM helped plan the analysis and provided critical inputs throughout the manuscript preparation. AS performed the data analysis. GSS, BPK and PRB were the surgeons who operated on the neonates described in the study. They reviewed the manuscript and provided critical inputs. RKK is the senior and the corresponding author who conceptualised the study, planned the analysis and revised the draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Institutional Ethics Committee of the Amrita Institute of Medical Sciences; Approval ID No. IEC-AIMS-2020-CARD-014.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. De-identified data on all patients in this study is available with RKK ( and these can be provided on formal request. RKK will seek approval from the Institutional Ethics committee before the data can be shared.

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