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Publications

Journal Article Epublish

PubMed: 42079909 DOI: 10.1016/j.xjon.2026.101700

Birth day of the week is associated with surgical timing and postoperative brain injury in neonates with congenital heart disease.

JTCVS Open 30:101700

Authors: Jennifer M Lynch, Marin Jacobwitz, J William Gaynor, Susan C Nicolson, Daniel J Licht

Affiliations

  • Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pa.
  • Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
  • Department of Bioengineering, University of Pennsylvania, Philadelphia, Pa.
  • Developmental Brain Institute, Children's National Hospital, Washington, DC.
  • Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa.
  • Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
  • Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.

Abstract

OBJECTIVES

White matter injury (WMI) is a common neurologic complication in neonates with critical congenital heart disease (CHD) and is associated with adverse neurodevelopmental outcomes. Although intraoperative and perioperative risk factors have been extensively studied, emerging evidence suggests that preoperative factors, including time from birth to surgery, may play a critical role in neurologic injury. We hypothesize that birth day of the week is associated with time to surgery and thus neurologic injury.

METHODS

We performed a retrospective analysis of 192 neonates born at term with critical CHD, 167 of whom underwent pre- and postoperative magnetic resonance imaging of the brain as part of a prospective observational study. The birth day of week and time to surgery were analyzed in relation to neurologic injury and patient demographics.

RESULTS

The birth day of the week was found to significantly impact time to surgery (P = .002), with neonates born on Wednesdays having the longest time from birth until surgery (median [interquartile range] 5 [5, 6] days) and the greatest incidence of postoperative WMI (n = 22, 82%). Birth day of the week predicted incidence of postoperative WMI (P = .02).

CONCLUSIONS

The day of week of birth may be an underrecognized contributor for neurologic injury in neonates with CHD. Given that surgical scheduling practices may contribute to the association between day of birth and time-to-surgery, optimizing delivery timing and surgical access may reduce the burden of WMI in this vulnerable population.

MeSH

Heart Defects, Congenital, Brain Injuries, Heart Diseases, Parturition, Infant, Newborn, Incidence, Heart, Brain