The advances in pediatric cardiac care over the past 30 years have resulted in a substantial decrease in morbidity and mortality associated with congenital heart disease (CHD). Most defects are now amenable to either anatomical or physiological repair early in infancy. Early complete biventricular repair is often the preferred approach, regardless of age or weight. Increasing numbers of premature and low birth weight infants present with additional challenges: high metabolic demands, end organ immaturity, altered stress response and increased susceptibility to injury. Finally, as the limits for managing CHD continue to be extended, fetal cardiac interventions emerge as the next frontier.
This chapter will describe general principles relevant to anesthesia for the newborn, including the premature and the very low birthweight neonate with CHD. The impact of prematurity, the outcome of cardiac surgery in the premature and full term neonate and new directions with fetal cardiac interventions will be discussed.