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

Medientyp: E-Artikel
Titel: Neonatal Outcomes in Very Preterm Infants With Severe Congenital Heart Defects: An International Cohort Study
Beteiligte: Norman, Mikael; Håkansson, Stellan; Kusuda, Satoshi; Vento, Maximo; Lehtonen, Liisa; Reichman, Brian; Darlow, Brian A.; Adams, Mark; Bassler, Dirk; Isayama, Tetsuya; Rusconi, Franca; Lee, Shoo; Lui, Kei; Yang, Junmin; Shah, Prakesh S.; Lui, Kei; Marshall, Peter; Schmidt, Peter; Dhawan, Anjali; Craven, Paul; de Waal, Koert; Simmer, Karen; Gill, Andy; Pillow, Jane; [...]
Erschienen: Ovid Technologies (Wolters Kluwer Health), 2020
Erschienen in: Journal of the American Heart Association
Sprache: Englisch
DOI: 10.1161/jaha.119.015369
ISSN: 2047-9980
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Beschreibung: <jats:sec xml:lang="en"><jats:title>Background</jats:title><jats:p xml:lang="en">Very preterm infants are at high risk of death or severe morbidity. The objective was to determine the significance of severe congenital heart defects (<jats:styled-content style="fixed-case">CHDs</jats:styled-content>) for these risks.</jats:p></jats:sec><jats:sec xml:lang="en"><jats:title>Methods and Results</jats:title><jats:p xml:lang="en">This cohort study included infants from 10 countries born from 2007–2015 at 24 to 31 weeks’ gestation with birth weights <1500 g. Severe<jats:styled-content style="fixed-case">CHDs</jats:styled-content>were defined by<jats:italic>International Classification of Diseases, Ninth Revision</jats:italic>(<jats:italic>ICD‐9</jats:italic>) and<jats:italic>Tenth</jats:italic>(<jats:italic>ICD‐10</jats:italic>) 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 (<jats:styled-content style="fixed-case">ORs</jats:styled-content>) were calculated. Analyses were stratified by type of<jats:styled-content style="fixed-case">CHD</jats:styled-content>, gestational age, and network. A total of 609 (0.77%) infants had severe<jats:styled-content style="fixed-case">CHD</jats:styled-content>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<jats:styled-content style="fixed-case">CHD</jats:styled-content>and 8.9% in controls (propensity score–matched<jats:styled-content style="fixed-case">OR</jats:styled-content>, 2.30; 95%<jats:styled-content style="fixed-case">CI</jats:styled-content>, 1.61–3.27). Severe<jats:styled-content style="fixed-case">CHD</jats:styled-content>was not associated with neonatal brain injury, necrotizing enterocolitis, or retinopathy of prematurity, whereas the<jats:styled-content style="fixed-case">OR</jats:styled-content>for bronchopulmonary dysplasia increased. Mortality was higher in all types, with the highest propensity score–matched<jats:styled-content style="fixed-case">OR</jats:styled-content>(4.96; 95% CI, 2.11–11.7) for<jats:styled-content style="fixed-case">CHD</jats:styled-content>causing congestive heart failure. While mortality did not differ between groups at <27 weeks’ gestational age, adjusted<jats:styled-content style="fixed-case">OR</jats:styled-content>for mortality in infants with CHD increased to 10.9 (95% CI, 5.76–20.70) at 31 weeks’ gestational age. Rates of<jats:styled-content style="fixed-case">CHD</jats:styled-content>and mortality differed significantly between networks.</jats:p></jats:sec><jats:sec xml:lang="en"><jats:title>Conclusions</jats:title><jats:p xml:lang="en">Severe<jats:styled-content style="fixed-case">CHD</jats:styled-content>is associated with significantly increased mortality in very preterm infants.</jats:p></jats:sec>
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