Outcome of preterm infants with congenital heart disease

doi:10.1067/mpd.2000.108568

The Journal of Pediatrics

Volume 137, Issue 5, November 2000, Pages 653-659

https://doi.org/10.1067/mpd.2000.108568 Get rights and content

Abstract

Objectives and study design: To evaluate the morbidity and mortality of preterm infants with congenital heart disease (CHD), a chart review was performed for infants with CHD, excluding isolated patent ductus arteriosus, who were <37 weeks’ gestation, weighed <2500 g, and were admitted to our neonatal intensive care unit from 1976 to 1999 (N = 201). Results: Patients in the study represented 1.9% of the total neonatal intensive care unit population <37 weeks’ gestation and <2500 g. The median gestational age was 33 weeks, and the mean birth weight was 1852 g. CHD diagnosis frequencies were similar to those reported in other large incidence studies, except for a higher percentage of conotruncal defects. The risk of necrotizing enterocolitis was 1.7 times higher and the overall mortality twice as high in our patients compared with patients in the neonatal intensive care unit who did not have CHD. Cardiac surgery (n = 133) was performed on 108 patients. During the recent period of 1985 to 1999, compared with our institution’s overall results for CHD surgery, the operative mortality rate was 10.4% versus 5.4% for closed procedures and 25.4% versus 10.5% for open procedures. The actuarial survival rate is 51% at 10 years; survival improved as the study period progressed. Conclusions: Infants with both CHD and prematurity did significantly worse than either group alone. Such outcome data are required for proper allocation of resources to care for this high-risk pediatric population. (J Pediatr 2000;137:653-9)

Section snippets

Methods

The study design was a retrospective chart review covering a period of 23 years. Patients were identified through a computer database maintained on all neonatal intensive care unit admissions. The database includes demographic information and admitting diagnosis and is updated continually, with additional diagnoses made during the hospitalization of each patient.

Eligibility criteria for inclusion in the study group were gestational age <37 weeks, birth weight <2500 g, and a diagnosis of CHD

Patients and Diagnoses

A total of 201 patients, 1.9% of the total NICU population for our time period, met the study criteria. The cardiac diagnoses of the patients in the study can be compared with data from 2 large incidence studies, the New England Regional Infant Cardiac Program¹⁰ and the Baltimore-Washington Infant Study.11, 12, 13 A few significant differences are seen. First, our incidence of VSD was similar to that found in the BWIS (study dates 1981 to 1989), both being higher than in the NERICP (study dates

Discussion

We have shown an increased prevalence of small for gestational age birth in infants with CHD in a population of exclusively preterm infants. Previous studies also suggest a tendency for low birth weight in infants with CHD, although inconsistent correction for prematurity often confounds this finding. The Baltimore-Washington Infant study¹¹ demonstrated a lower birth weight distribution for CHD cases versus a control group. The mean gestational age was not significantly different for cases and

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Cited by (100)

Congenital heart defects and preterm birth: Outcomes from a referral center
2023, Revista Portuguesa de Cardiologia
Preterm birth and congenital heart defects are two major causes of neonatal and infant mortality. However, the relationship between them has not yet been fully clarified.
To determine the prevalence and spectrum of congenital heart defects in preterms, the specific associations between categories of congenital heart defects and preterm birth and to establish the influence on outcomes.
Observational, case-control analysis that included 448 live births with congenital heart defects born between 2003 and 2017. Preterm with congenital heart defects were the case subjects and term neonates with congenital heart defects the control subjects.
Of the newborns with congenital heart defects, 23% were preterm. The odds of congenital heart defects in preterm were twofold higher than for term neonates (p<0.0001), even when considering only those with severe congenital heart defects (p=0.0002). The odds in preterm were 9.2-fold higher for abnormalities of the atria and atrial septum (p<0.0001) and two-fold higher for abnormalities of the ventricles and ventricular septum (p<0.0001) compared with term neonates. The neonatal mortality rate in the preterm group was not statistically different from that of the term group with congenital heart defects (p=0.799) or severe congenital heart defects (p=0.554).
Preterm have more than twice as many congenital heart defects as term neonates. Although the etiology of prematurity between infants with congenital heart defects is still uncertain, our findings highlight a possible relationship between prematurity and congenital heart defects.
A prematuridade e a cardiopatia congénita são as duas principais causas de morbimortalidade neonatais. Contudo, a relação entre essas duas entidades não está totalmente esclarecida.
Determinar a prevalência e espetro de cardiopatias congénitas em prematuros, a associação entre diferentes categorias de cardiopatias congénitas e a prematuridade e determinar se a prematuridade tem influência na mortalidade neonatal nos recém-nascidos com cardiopatia congénita.
Estudo observacional, caso-controlo, que incluiu 448 recém-nascidos com diagnóstico de cardiopatia congénita no período neonatal entre 2003 e 2017. Os objetos de estudo foram os prematuros com cardiopatia congénita e os controlos os recém-nascidos de termo com cardiopatia congénita.
Dos recém-nascidos com cardiopatia congénita 23% eram prematuros. O odds ratio de cardiopatia congénita em prematuros foi duas vezes maior do que em recém-nascidos de termo (p<0,0001), mesmo considerando apenas cardiopatia congénita grave (p=0,0002). O odds ratio em prematuros foi 9,2 vezes superior para defeitos auriculares ou do septo interauricular (p<0,0001) e duas vezes superior para defeitos dos ventrículos ou do septo interventricular (p<0,0001) do que em recém-nascidos de termo. Não existiram diferenças significativas na mortalidade neonatal entre prematuros e recém-nascidos de termo com cardiopatia congénita (p=0,799) ou cardiopatia congénita grave (p=0,554).
Os prematuros têm mais do dobro do risco de cardiopatia congénita comparativamente com os recém-nascidos de termo. Embora a etiologia da prematuridade entre recém-nascidos com cardiopatia congénita ainda seja incerta, os nossos resultados destacam uma possível relação entre prematuridade e cardiopatia congénita.
Very low birth weight infants with congenital heart disease: A multicenter cohort study in Japan
2022, Journal of Cardiology
Citation Excerpt :
A recent systematic review and meta-analysis suggested that SGA was an important factor for mortality [30]. Regarding chromosomal/named anomalies, Dees et al., in a study of preterm (<35 weeks) and low birth weight (2500 g) of infants who were admitted to the NICU, reported that the proportion of trisomy 18 and trisomy 13 were 3 % and 1 %, respectively [3]. The proportion of trisomy 18 and trisomy 13 (25.4 %, 32/126) in our cohort was relatively high when compared to their report.
The frequency, mortality, and morbidity of very low birth weight (VLBW) infants with congenital heart disease (CHD) in Asian countries are limited. In addition, little is known about the risk factors of death in these infants.
A retrospective, multicenter cohort study was conducted. VLBW infants with CHD born between 2006 and 2010, and followed to 5 years of age, were included in the analysis. Multiple logistic regression analysis was performed to identify the risk factors of death.
Among 3247 VLBW infants, 126 various CHDs (3.9 %) were identified. The most common lesions were ventricular septal defect, tetralogy of Fallot (TOF), and coarctation of the aorta/interrupted aortic arch, in that order. The proportions of left-sided and right-sided outflow obstruction (TOF, pulmonary stenosis) were 15.1 % and 15.9 %, respectively. Trisomy 18 and trisomy 13 were present in 32 (25.4 %) of 126 VLBW infants with CHD. Nine patients were lost to follow-up. Overall, 45 patients (35.7 %) died up to 5 years of age. Serious CHD [odds ratio (OR), 19.2; 95 % confidential interval (CI), 3.94–93.11; p < 0.0001], sepsis (OR, 42.3; 95 % CI, 5.39–332.22; p < 0.0001), chromosomal /named anomalies (OR, 7.50; 95%CI, 2.09–26.94; p = 0.001), and no-invasive treatments (OR, 9.89; 95%CI, 2.28–42.91; p = 0.001) were associated with death. On excluding chromosomal anomalies, twelve of 71 patients (16.9 %) died, and only sepsis (OR, 35.5, 95%CI, 2.63–477.1; p = 0.0008) was an independent risk factor.
Trisomy 18 and trisomy 13 of chromosomal anomalies are frequently associated with VLBW infants with CHD. The mortality of VLBW infants with CHD is high, even when chromosomal anomalies are excluded. Sepsis has a significant impact on death in VLBW infants with CHD.
Mortality and Major Neonatal Morbidity in Preterm Infants with Serious Congenital Heart Disease
2021, Journal of Pediatrics
To investigate the trends of 1-year mortality and neonatal morbidities in preterm infants with serious congenital heart disease (CHD).
This cohort study used a population-based administrative dataset of all liveborn infants of 26-36 weeks gestational age with serious CHD born in California between 2011 and 2017. We assessed 1-year mortality and major neonatal morbidities (ie, retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage grade >2, and periventricular leukomalacia) across the study period and compared these outcomes with those in infants without CHD.
We identified 1921 preterm infants with serious CHD. The relative risk (RR) of death decreased by 10.6% for each year of the study period (RR, 0.89; 95% CI, 0.84-0.95), and the RR of major neonatal morbidity increased by 8.3% for each year (RR, 1.08; 95% CI, 1.02-1.15). Compared with preterm neonates without any CHD (n = 234 522), the adjusted risk difference (ARD) for mortality was highest at 32 weeks of gestational age (9.7%; 95% CI, 8.3%-11.2%), that for major neonatal morbidity was highest at 28 weeks (21.9%; 95% CI, 17.0%-26.9%), and that for the combined outcome was highest at 30 weeks (26.7%; 95% CI, 23.3%-30.1%).
Mortality in preterm neonates with serious CHD decreased over the last decade, whereas major neonatal morbidities increased. Preterm infants with a gestational age of 28-32 weeks have the highest mortality or morbidity compared with their peers without CHD. These results support the need for specialized and focused medical neonatal care in preterm neonates with serious CHD.
Single-Center Comparison of Outcomes Following Cardiac Surgery in Low Birth Weight and Standard Birth Weight Neonates
2021, Journal of Pediatrics
To compare outcomes between low birth weight (LBW; <2.5 kg) and standard birth weight neonates undergoing cardiac surgery.
A single-center retrospective study of neonates undergoing cardiac surgery with cardiopulmonary bypass from 2012 to 2018. LBW neonates were 1:2 propensity score–matched to standard birth weight neonates (n = 93 to n = 186) using clinical characteristics. The primary and secondary outcomes were survival to hospital discharge and postoperative complications, respectively. After matching, regression analyses were conducted to compare outcomes.
The LBW group had a higher proportion of premature neonates than the standard birth weight group (60% vs 8%; P < .01) and were less likely to survive to hospital discharge (88% vs 95%; OR, 0.39; 95% CI, 0.15-0.97). There was no difference in unplanned cardiac reoperations or catheter-based interventions, cardiac arrest, extracorporeal membrane oxygenation, infection, and end-organ complications between the groups. Among LBW infants, survival was improved at weight >2 kg.
LBW is a risk factor for decreased survival. LBW neonates weighing >2 kg have survival comparable to those weighing >2.5 kg.
Trends in Preterm Delivery among Singleton Gestations with Critical Congenital Heart Disease
2020, Journal of Pediatrics
To examine state-wide population trends in preterm delivery of children with critical congenital heart disease (CHD) over an 18-year period. We hypothesized that, coincident with early advancements in prenatal diagnosis, preterm delivery initially increased compared with the general population, and more recently has decreased.
Data from the Texas Public Use Data File 1999-2016 was used to evaluate annual percent preterm delivery (<37 weeks) in critical CHD (diagnoses requiring intervention at <1 year of age). We first evaluated for pattern change over time using joinpoint segmented regression. Trends in preterm delivery were then compared with all Texas livebirths. We then compared trends examining sociodemographic covariates including race/ethnicity, sex, and neighborhood poverty levels.
Of 7146 births with critical CHD, 1339 (18.7%) were delivered preterm. The rate of preterm birth increased from 1999 to 2004 (a mean increase of 1.69% per year) then decreased between 2005 and 2016 (a mean decrease of −0.41% per year). This represented a faster increase and then a similar decrease to that noted in the general population. Although the greatest proportion of preterm births occurred in newborns of Hispanic ethnicity and non-Hispanic black race, newborns with higher neighborhood poverty level had the most rapidly increasing rate of preterm delivery in the first era, and only a plateau rather than decrease in the latter era.
Rates of preterm birth for newborns with critical CHD in Texas first were increasing rapidly, then have been decreasing since 2005.
Neurodevelopmental outcomes of children with congenital heart disease: A review
2019, Current Problems in Pediatric and Adolescent Health Care
Citation Excerpt :
Low birth weight, less than 2.5 kg, may pose a technical hurdle for surgical repair, and has been implicated as one of the major reasons for deferring cardiac surgical procedures on CPB. Several small retrospective studies have shown that early mortality of low birth weight infants undergoing cardiac surgery at <2.5 kg ranges from 15 to 36% with those born preterm having twice the risk compared to term infants.44–53 Interestingly, white matter injury is the most common type of brain injury noted in preterm infants and term infants with CHD.54,55
Congenital heart defects are the most common birth anomaly affecting approximately 1% of births. With improved survival in this population, there is enhanced ability to assess long-term morbidities including neurodevelopment. There is a wide range of congenital heart defects, from those with minimal physiologic consequence that do not require medical or surgical intervention, to complex structural anomalies requiring highly specialized medical management and intricate surgical repair or palliation. The impact of congenital heart disease on neurodevelopment is multifactorial. Susceptibility for adverse neurodevelopment increases with advancing severity of the defect with initial risk factors originating during gestation. Complex structural heart anomalies may pre-dispose the fetus to abnormal circulatory patterns in utero that ultimately impact delivery of oxygen rich blood to the fetal brain. Thus, the brain of a neonate born with complex congenital heart disease may be particularly vulnerable from the outset. That vulnerability is compounded during the newborn period and through childhood, as this population endures a myriad of medical and surgical interventions. For each individual patient, these factors are likely cumulative and synergistic with progression from fetal life through childhood. This review discusses the spectrum of risk factors that may impact neurodevelopment in children with congenital heart disease, describes current recommendations and practices for neurodevelopmental follow-up of children with congenital heart disease and reviews important neurodevelopmental trends in this high risk population.

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^☆: Reprint requests: Debra A. Dodd, MD, D-2220 Medical Center North, Vanderbilt University Medical Center, Nashville, TN 37232-2572.

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Original ArticlesOutcome of preterm infants with congenital heart disease☆

Abstract

Section snippets

Methods

Patients and Diagnoses

Discussion

Am J Cardiol

J Am Coll Cardiol

Ann Thorac Surg

J Pediatr

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Obstet Gynecol

J Pediatr

J Pediatr Surg

The transition from fetal to neonatal circulation: normal responses and implications for infants with heart disease

Semin Perinatol

Original Articles
Outcome of preterm infants with congenital heart disease☆