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Multicenter Study
. 2020 Mar 3;9(5):e015369.
doi: 10.1161/JAHA.119.015369. Epub 2020 Feb 21.

Neonatal Outcomes in Very Preterm Infants With Severe Congenital Heart Defects: An International Cohort Study

Mikael Norman  1 , Stellan Håkansson  2 , Satoshi Kusuda  3 , Maximo Vento  4 , Liisa Lehtonen  5 , Brian Reichman  6 , Brian A Darlow  7   8 , Mark Adams  9 , Dirk Bassler  9 , Tetsuya Isayama  10 , Franca Rusconi  11 , Shoo Lee  12   13 , Kei Lui  14 , Junmin Yang  13 , Prakesh S Shah  12   13 ; International Network for Evaluation of Outcomes in Neonates (iNeo) Investigators* †
Collaborators, Affiliations
Multicenter Study

Neonatal Outcomes in Very Preterm Infants With Severe Congenital Heart Defects: An International Cohort Study

Mikael Norman et al. J Am Heart Assoc. .

Abstract

Background Very preterm infants are at high risk of death or severe morbidity. The objective was to determine the significance of severe congenital heart defects (CHDs) for these risks. Methods and Results This cohort study included infants from 10 countries born from 2007-2015 at 24 to 31 weeks' gestation with birth weights <1500 g. Severe CHDs were defined by International Classification of Diseases, Ninth Revision (ICD-9) and Tenth (ICD-10) codes and categorized as those compromising systemic output, causing sustained cyanosis, or resulting in congestive heart failure. The primary outcome was in-hospital mortality. Secondary outcomes were neonatal brain injury, necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity. Adjusted and propensity score-matched odds ratios (ORs) were calculated. Analyses were stratified by type of CHD, gestational age, and network. A total of 609 (0.77%) infants had severe CHD and 76 371 without any malformation served as controls. The mean gestational age and birth weight were 27.8 weeks and 1018 g, respectively. The mortality rate was 18.6% in infants with CHD and 8.9% in controls (propensity score-matched OR, 2.30; 95% CI, 1.61-3.27). Severe CHD was not associated with neonatal brain injury, necrotizing enterocolitis, or retinopathy of prematurity, whereas the OR for bronchopulmonary dysplasia increased. Mortality was higher in all types, with the highest propensity score-matched OR (4.96; 95% CI, 2.11-11.7) for CHD causing congestive heart failure. While mortality did not differ between groups at <27 weeks' gestational age, adjusted OR for mortality in infants with CHD increased to 10.9 (95% CI, 5.76-20.70) at 31 weeks' gestational age. Rates of CHD and mortality differed significantly between networks. Conclusions Severe CHD is associated with significantly increased mortality in very preterm infants.

Keywords: cardiac malformation; mortality; newborn infant; preterm birth.

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Figures

Figure 1
Figure 1
Flow chart: inclusion and severe congenital heart defects (CHDs) by their manifestation in very preterm, singleton infants.
Figure 2
Figure 2
Mortality rates (lines) by gestational age among very preterm infants with or without severe congenital heart defects (CHDs). aOR (grey bars) indicates adjusted odds ratio for mortality.
See this image and copyright information in PMC

References

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