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Published on: July 18, 2014
Clinical outcomes in very low birth weight infants with major congenital heart defects
Anna W Anderson1, P Brian Smith2, Kristin M Corey3
1Texas A&M University, College Station, TX, USA.
Insights
Major congenital heart disease (CHD) in premature infants is linked to high mortality and morbidity. Despite advancements, survival rates and the incidence of major complications in these vulnerable infants have not improved over time.
Area of Science:
- Neonatal care
- Pediatric cardiology
- Public health
Background:
- Major congenital heart disease (CHD) combined with prematurity presents significant challenges.
- Previous research has not fully detailed the morbidity and mortality risks for this specific patient group.
Purpose of the Study:
- To investigate the outcomes of very low birth weight (VLBW) infants diagnosed with major CHD.
- To describe trends in mortality and morbidity over time within this population.
Main Methods:
- A retrospective cohort study was conducted using data from 1997 to 2012.
- Infants weighing less than 1500 grams with major CHD from neonatal intensive care units were included.
- Outcomes were analyzed based on birth weight, type of CHD, and time period.
Main Results:
- Out of 105,539 VLBW infants, 299 (0.3%) had major CHD.
- The most common CHDs were coarctation of the aorta, atrioventricular septal defect, and tetralogy of Fallot.
- Overall mortality was 55%, with significant variation by lesion type. Mortality did not change significantly over the study period (1997-2012).
- 73% of infants experienced at least one comorbidity or died.
Conclusions:
- Major CHD in VLBW infants is associated with substantial morbidity and mortality.
- While specific lesion types influence survival, overall survival rates and the incidence of major morbidities have remained stagnant.
- There is a critical need for improved management strategies for premature infants with complex heart conditions.
Background:
The combination of major congenital heart disease (CHD) and prematurity is associated with poor prognosis, but previous studies have not fully characterized morbidity and mortality in this population. We conducted a retrospective cohort study of very low birth weight (VLBW) infants with major CHD to describe outcomes, including mortality, over time.
Methods:
We included all infants <1500 g birth weight with major CHD discharged from Pediatrix Medical Group neonatal intensive care units from 1997 to 2012. We report incidences of major CHD in VLBW infants and compare mortality and morbidity by infant birth weight, type of major CHD, and time period.
Results:
Of 105,539 VLBW infants, 299 (0.3%) were diagnosed with 15 different major CHDs. Coarctation of the aorta (n=67, 22%), atrioventricular septal defect (n=58, 19%), and tetralogy of Fallot (n=53, 18%) were the most common major CHDs identified. Overall mortality was 163/299 (55%). Mortality was ≥70% for 10 lesions and <30% for isolated aortic valve stenosis (6/30, 20%). Mortality in infants with major CHD did not significantly change over time: 76/133 (57%) in 1997-2005, 49/95 (52%) in 2006-2009, and 38/71 (54%) in 2010-2012 (p=0.70). The majority of infants suffered ≥1 comorbidity or died (218/299, 73%).
Conclusion:
Major CHD is associated with high morbidity and mortality. While mortality varies by lesion, overall survival and incidence of major morbidity have not improved over time.
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