Thread by @MGaies

#PedsICU #PedsCICU #PedsCards Drawing attention to this @pc4quality study by @JustinElhoff and Martina Steurer-Miller (needs a handle!) and team....1/x

Relationship between gestational age and outcomes after congenital heart surgery pubmed.ncbi.nlm.nih.gov/33080235/

This is one of those great studies where we followed the data and found something that was interesting to us, worthy of follow-up, and potentially actionable. In addition to studying the relationship between gestational age and outcome after #CHD surgery...2/x

We looked at the association between corrected gestational age and outcome. We frequently struggle to determine the "right" time to take a premature patient with CHD to the operating room. On the one hand, we want them to achieve sufficient organ maturity...3/x

particularly to avoid neurologic injury after bypass. On the other hand waiting exposes them to an inadequate circulation, indwelling lines, and other risks of critical illness. So the question of whether surgery at a later corrected gestational age could be better...4/x

is VERY clinically relevant. This research question is directly related to the decisions we make daily in the #PedsCICU. So what did we find?...5/x

When adjusting for patient comorbidities and the complexity of the operation, later gestational age was associated with improved survival. Based on the mortality data, it appeared optimal wait until closer to 39 weeks corrected GA. However, many ?s remain...6/x

How is this assoc. different across diagnoses? What data would suggest that you really shouldn't wait (e.g. specific patient pathophysiology)? How can we monitor patients to determine when waiting becomes counterproductive? So many opportunities to explore these ?s...7/x

All of that said, it does raise the question of whether we should be waiting to operate on premature neonates with #CHD if the physiology, oxygen delivery, and other risks are under reasonable control. Should be interesting to see the reactions to these data. 8/8 end.