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Published on: July 18, 2014
Gestational Age and Outcomes in Critical Congenital Heart Disease
Martina A Steurer1,2, Rebecca J Baer3, Roberta L Keller4
1Departments of Pediatrics, steurermullerm@peds.ucsf.edu.
Insights
Infants with critical congenital heart disease (CCHD) face increased neonatal morbidity and mortality risks, particularly those born preterm. Gestational age significantly impacts outcomes, with earlier births showing higher risks.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Public Health
Background:
- Gestational age (GA) is a critical factor in neonatal outcomes.
- The impact of GA on neonatal morbidities in infants with critical congenital heart disease (CCHD) is not well understood.
Purpose of the Study:
- To quantify GA-specific mortality and neonatal morbidity in infants diagnosed with CCHD.
- To determine the relationship between gestational age and adverse outcomes in CCHD infants.
Main Methods:
- A large cohort study utilizing linked birth certificate, hospital discharge, readmission, and death records.
- Inclusion criteria: infants aged 22 to 42 weeks GA without chromosomal anomalies, born between 2005-2012.
- International Classification of Diseases, Ninth Revision codes identified CCHD and specific neonatal morbidities; adjusted absolute risk differences were calculated.
Main Results:
- 0.23% of live births had CCHD, with incidence peaking at 29-31 weeks GA.
- Infants with CCHD born at 34-36 weeks had higher mortality/morbidity risk than those born at 37-38 weeks (aARD 9.1%).
- Infants with CCHD born at 37-38 weeks had higher mortality/morbidity risk than those born at 39-42 weeks (aARD 3.2%).
Conclusions:
- Infants born with CCHD experience significantly elevated risks of neonatal morbidity and mortality.
- Increased morbidity risk persists across all gestational ages compared to term-born infants (39-42 weeks).
- Gestational age is a crucial determinant of CCHD outcomes, necessitating tailored clinical care strategies.
Background And Objectives:
It is unknown how gestational age (GA) impacts neonatal morbidities in infants with critical congenital heart disease (CCHD). We aim to quantify GA-specific mortality and neonatal morbidity in infants with CCHD.
Methods:
Cohort study using a database linking birth certificate, infant hospital discharge, readmission, and death records, including infants 22 to 42 weeks' GA without chromosomal anomalies (2005-2012, 2 988 925 live births). The International Classification of Diseases, Ninth Revision diagnostic and procedure codes were used to define CCHD and neonatal morbidities (intraventricular hemorrhage, retinopathy, periventricular leukomalacia, chronic lung disease, necrotizing enterocolitis). Adjusted absolute risk differences (ARDs) with 95% confidence intervals (CIs) were calculated.
Results:
We identified 6903 out of 2 968 566 (0.23%) infants with CCHD. The incidence of CCHD was highest at 29 to 31 weeks' GA (0.9%) and lowest at 39 to 42 weeks (0.2%). Combined neonatal morbidity or mortality in infants with and without CCHD was 82.8% and 57.9% at <29 weeks and declined to 10.9% and 0.1% at 39 to 42 weeks' GA. In infants with CCHD, being born at 34 to 36 weeks was associated with a higher risk of death or morbidity than being born at 37 to 38 weeks (adjusted ARD 9.1%, 95% CI 5.5% to 12.7%), and being born at 37 to 38 weeks was associated with a higher risk of death or morbidity than 39 to 42 weeks (adjusted ARD 3.2%, 95% CI 1.6% to 4.9%).
Conclusions:
Infants born with CCHD are at high risk of neonatal morbidity. Morbidity remains increased across all GA groups in comparison with infants born at 39 to 42 weeks. This substantial risk of neonatal morbidity is important to consider when caring for this patient population.
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