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

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.