Funding outcome

Current research has suggested that suboptimal fetal environments and adverse early life exposures (AELE) may contribute to adult cardiovascular disease. Maternal diabetes, a poorly functioning placenta, and premature birth have all been shown to impact heart muscle and blood vessel health in older childhood. Infants with congenital heart disease (CHD) with such AELE have generally worse surgical outcomes in infancy, the cause of which has not been fully defined. Animal research has suggested that certain exposures before birth observed most commonly when the placenta does not function well (low oxygen levels and nutrient deficiencies) can result in changes to the heart muscle that may increase the risk of injury at the time of open heart surgery; however, this has not been examined in models of maternal diabetes or preterm birth and it has not been examined in clinical patients to know whether it even happens in humans. Our retrospective study will explore the operative outcomes following open heart surgery for CHD at <1 year of age of affected infants born small due to poor placental function, to a diabetic mother or born prematurely (< 37 weeks), comparing the outcomes with those of age-matched infants undergoing the same surgery but who were born with a normal birth weight to healthy mothers at greater than or equal to 37 weeks. We expect to see that infants with AELEs will have evidence of worse surgical outcomes due to greater heart muscle injury as evidenced by low heart output and heart dysfunction in the first 24 hours after surgery, greater number of deaths and longer intensive care and hospital stays. If in fact infants undergoing open heart surgery for CHD who have AELE are at higher risk for being more sick after surgery and this contributes to worse outcomes, this would be important for presurgery counseling, and could lead to further study into the mechanisms responsible and novel strategies to prevent the injury and improve outcomes of affected infants.