Medical Management Considerations of Premature Infants with Congenital Heart Disease

In this manuscript, we will review core noncardiac medical management principles for the preterm infant with congenital heart disease (CHD). We describe common respiratory diseases of the newborn period, apnea of prematurity, the significance of thermoregulation, and management of hyperbilirubinemia. Taken together, these management considerations optimize neurodevelopment and growth of the infant with CHD while minimizing significant neonatal comorbidities.

The comorbidities of prematurity affect both neonates with and without CHD. Respiratory distress syndrome can be a significant consequence of premature birth, and early surfactant administration is associated with decreased air leak, bronchopulmonary dysplasia (BPD), and mortality. If invasive mechanical ventilation is necessary, volume-targeted ventilation is preferred in preterm neonates with associated shorter duration of mechanical ventilation and decreased comorbidities. Recommendations for the management of hypoglycemia in infants exist, but are dependent on enteral feeding; thus, these recommendations may not be applicable to the neonate with CHD who cannot tolerate enteral feeding. Hypothermia is a common problem in premature infants and can result in high tissue oxygen demand and consumption with subsequent metabolic acidosis. Such effects can be exacerbated in the infant with CHD and may increase the risk for morbidities and mortality.

Though there have been many medical and surgical advancements in the care of preterm infants with CHD, the rates of morbidity and mortality remain high. Understanding key principles related to common complications of prematurity can be critical to improving long-term outcomes.