Dear Editor,
We appreciate the insightful comments by Dr Hannes Sallmon regarding our case series [1]. In our present report [2], the lowest weight we managed was 1742 g at 32 weeks gestation in Case 2. The case Dr Sallmon presented was more premature and had a lower birth weight than ours, which makes the management extremely challenging. Previous reports have shown that premature infants with congenital heart disease (CHD) born between 25 and 32 weeks gestation have a 7.5-fold higher in-hospital mortality rate compared to premature infants without CHD, with even higher mortality rates reported in cases complicated with hypoplastic left heart syndrome (HLHS) [3]. Additionally, Carvajal et al. reported that less than 11% of HLHS infants weighing less than 2 kg survived to one year [4]. Furthermore, the combination of prematurity and esophageal atresia in infants is associated with increased postoperative complications [5].
We agree with Dr. Sallmon that our recommended treatment strategies pose significant challenges when applied to premature neonates. Survival in cases with severe CHD, esophageal atresia, and prematurity is exceedingly difficult to achieve, and even if survival is attained, the likelihood of severe complications remains high. At present, we cannot specify the gestational age or weight threshold at which our treatment strategies can be applied. Providing the families with sufficient explanations of risks, potential complications, and prognosis, and presenting comfort care as a viable option in cases of extreme prematurity, are also important aspects of the management of this severe condition.
Declaration of competing interest
None declared.
References
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