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Observational Study
. 2017 May 15;17(1):124.
doi: 10.1186/s12887-017-0875-z.

Impact of preterm birth on infant mortality for newborns with congenital heart defects: The EPICARD population-based cohort study

Enora Laas  1 , Nathalie Lelong  1 , Pierre-Yves Ancel  1 , Damien Bonnet  2 , Lucile Houyel  3 , Jean-François Magny  4 , Thibaut Andrieu  1 , François Goffinet  1   5 , Babak Khoshnood  6 ; EPICARD study group
Collaborators, Affiliations
Observational Study

Impact of preterm birth on infant mortality for newborns with congenital heart defects: The EPICARD population-based cohort study

Enora Laas et al. BMC Pediatr. .

Abstract

Background: Congenital heart defects (CHD) and preterm birth (PTB) are major causes of infant mortality. However, limited data exist on risk of mortality associated with PTB for newborns with CHD. Our objective was to assess impact of PTB on risk of infant mortality for newborns with CHD, while taking into account the role of associated anomalies and other potentially confounding factors.

Methods: We used data on 2172 live births from a prospective population-based cohort study of CHD (the EPICARD Study) and compared neonatal, post-neonatal and overall infant mortality for infants born at <32, 32-34 and 35-36 weeks vs. those born at term (37-41 weeks).

Results: Preterm newborns had a 3.8-fold higher risk of infant death (17.9%) than term newborns (4.7%), RR 3.8, 95%CI 2.7-5.2; the risk associated with PTB was more than four-fold higher for neonatal (RR 4.3, 95% CI 2.9-6.6) and three-fold higher for post-neonatal deaths (RR 3.0, 95% CI 1.7-5.2). Survival analysis showed that newborns <35 weeks had a higher risk of mortality, which decreased but persisted after exclusion of associated anomalies and adjustment for potential confounders.

Conclusions: Preterm birth is associated with an approximately four-fold higher risk of infant mortality for newborns with CHD. This excess risk appears to be mostly limited to newborns <35 weeks of gestation and is disproportionately due to early deaths.

Keywords: Congenital heart defects; Mortality; Preterm birth.

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Figures

Fig. 1
Fig. 1
Flow chart – Study Population
Fig. 2
Fig. 2
Gestational-age specific Kaplan-Meier survival curves for infants with isolated CHD
Fig. 3
Fig. 3
Gestational-age specific Kaplan-Meier survival curves for infants with isolated major CHD
See this image and copyright information in PMC

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