Short-midterm outcomes of preoperative extrauterine growth restriction in premature infants with critical congenital heart disease after surgery.

Objective: To assess the factors associated with early occurrence of extrauterine growth restriction (EUGR) in preterm infants with critical congenital heart disease (CCHD) and their short-midterm outcomes.

Methods: This was a single-center retrospective study including a cohort of all premature infants (< 37weeks) undergoing surgery for CCHD at Guangdong Provincial People's Hospital from 2011 to 2022. According to the diagnostic and exclusion criteria, the subjects were divided into malnourished and un-malnourished groups. The clinical characteristics and nutrition outcomes of patients were collected and compared.

Results: Among the entire cohort of 118 preterm neonates with critical congenital heart disease (CCHD), 46 (39.0%) were malnourished before the operation, and 72 (61.0%) were non-malnourished. The BWZ (birth weight Z-score) [OR = 0.041, (0.012, 0.143), P < 0.001] of preoperative extrauterine growth restriction (EUGR) was lower. In addition, the preoperational non-EUGR group had earlier operation age [OR = 1.076, (1.032, 1.122), P = 0.001] and less liquid volume [OR = 1.032, (1.000, 1.066), P = 0.050]. After surgery, the preoperative EUGR group fasted [(5.28 ± 0.933) vs. (3.92 ± 0.411) days, P = 0.021] and hospitalized [(43.10 ± 3.683) vs. (31.89 ± 2.301) days, P = 0.007] for a longer time. The WAZ (weight of age Z-score) of the preoperative EUGR group was lower at discharge [(-3.84 ± 0.166) vs. (-1.75 ± 0.138), P < 0.001] and more of them were still malnourished [13(38.2%) vs. 4(5.6%), P = 0.006] till 2-year follow-up. We found 14.41% mortality total, of which 11.86% was in hospital.

Conclusion: Preoperative low weight-for-age, influenced by both congenital (e.g., SGA) and postnatal factors, predicts prolonged recovery and persistent growth deficits in preterm infants with CCHD. Comprehensive nutritional strategies must address both intrauterine and extrauterine contributors to growth failure.