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Review
. 2023 Jan 27;10(2):47.
doi: 10.3390/jcdd10020047.

Early Mortality in Infants Born with Neonatally Operated Congenital Heart Defects and Low or Very-Low Birthweight: A Systematic Review and Meta-Analysis

Neil Derridj  1   2 , Ali Ghanchi  1   3 , Damien Bonnet  2 , Pauline Adnot  4 , Makan Rahshenas  1 , Laurent J Salomon  3 , Jérémie F Cohen  1   4 , Babak Khoshnood  1
Affiliations
Review

Early Mortality in Infants Born with Neonatally Operated Congenital Heart Defects and Low or Very-Low Birthweight: A Systematic Review and Meta-Analysis

Neil Derridj et al. J Cardiovasc Dev Dis. .

Abstract

Mortality outcomes of children with isolated neonatally operated congenital heart defects (CHDs) born with a low (LBW), moderately low (MLBW) or very-low birthweight (VLBW) remain ambiguous. We searched Medline and Embase (inception until October 2021) and included studies that evaluated early mortality. The risk of bias was assessed using the Critical Appraisal Skills Program cohort checklist. Meta-analysis involved random-effects models. We explored variability in mortality across birthweight subgroups, CHD types, and study designs. From 2035 reports, we included 23 studies in qualitative synthesis, and the meta-analysis included 11 studies (1658 CHD cases), divided into 30 subcohorts. The risk of bias was low in 4/11 studies included in the meta-analysis. Summary mortality before discharge or within one month after surgery was 37% (95%CI 27-47). Early mortality varied by birthweight (VLBW 56%, MLBW 15%, LBW 16%; p = 0.003) and CHD types (hypoplastic left heart syndrome (HLHS) 50%, total anomalous pulmonary venous return (TAPVR) 47%, transposition of the great arteries (TGA) 34%, coarctation of the aorta (CoA) 16%; p = 0.13). Mortality was higher in population-based studies (49% vs. 10%; p = 0.006). One-third of infants born with neonatally operated isolated CHDs and LBW, MLBW, or VLBW died within 30 days after surgery. Mortality varied across infant and study characteristics. These results may help clinicians assess neonatal prognosis. PROSPERO registration CRD42020170289.

Keywords: coarctation of the aorta; congenital heart defects; hypoplastic left heart syndrome; low birth weight; meta-analysis; mortality; systematic review; total anomalous pulmonary venous return; transposition of the great arteries.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart. Legend: ECA, extracardiac anomaly; GA/S, genetic anomaly and/or syndrome; LBW, low birthweight; SGA, small for gestational age; VLBW, very-low birthweight.
Figure 2
Figure 2
Early mortality in infants born with severe neonatally operated congenital heart defects and a low or very-low birthweight: Meta-analysis. Legend: CHD, congenital heart defect; LBW, low birthweight (i.e., <2500 g); MLBW, moderately low birthweight (i.e., 1500–2499 g), VLBW, very-low birthweight (i.e., <1500 g); HLHS, hypoplastic left heart syndrome; TAPVR, total anomalous pulmonary venous return; CoA, coarctation of the aorta; TGA, transposition of the great arteries; Hosp, hospital-based; Pop, population-based.
Figure 3
Figure 3
Funnel plot with pseudo 95% confidence limits.
See this image and copyright information in PMC

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