The incidence of low birth weight among...

The incidence of low birth weight among newborns with TGA is reported to be 3.05% [78], which compares favourably with the reported 15% overall incidence of prematurity or low birth weight in neonates with congenital heart disease [79]. Although it is clear that low birth weight and prematurity are different factors, they often coexist. Low birth weight (≤2.5 kg), very low birth weight (≤1.5 kg) and, less so, prematurity [80] present technical and physiological challenges to complete repair in the neonate. Additional comorbidities from other organ systems (central nervous system, renal, gastrointestinal) increase the morbidity and mortality rates of these infants both short and long term [81]. More specifically, in transposition, large, multi-institutional studies in Europe and North America have demonstrated increased mortality rates after an ASO in infants weighing <2.5 kg [82, 83]. However, it has been shown that delaying repair to allow for weight gain confers higher preoperative morbidity and early mortality without any associated benefit [84, 85]. Furthermore, delaying intervention for TGA IVS results in deconditioning of the left ventricle, rendering the patient a potentially poor candidate for a primary ASO. Centres have reported early repair [86], primary repair as late as age 3 months, late single-stage repair with postoperative mechanical circulatory support and two-stage repair (i.e. pulmonary artery banding with or without aortopulmonary shunt placement followed by an ASO in 7–14 days) [86, 87] with acceptable results.

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Recommendations for perinatal management in a neonatal intensive care unit

ASO : arterial switch operation; ECLS: extracorporeal life support; IV: intravenous; PGE1: prostaglandin E1; VAD: ventricular assist device.

^aClass of recommendation.

^bLevel of evidence.

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