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Surgical Interventions in Infants Born Preterm with Congenital Heart Defects: An Analysis of the Kids' Inpatient
Jagdish Desai1, Sanjeev Aggarwal2, Steven Lipshultz2
1Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS; Division of Neonatology, Children's Hospital of Michigan, Wayne State University, Detroit, MI.
Insights
Survival rates for preterm infants with congenital heart defects (CHDs) are high, suggesting surgery may be beneficial even for high-risk cases. Careful consideration of individual factors is key for optimizing outcomes in these vulnerable infants.
Area of Science:
- Neonatalogy
- Pediatric Cardiology
- Congenital Heart Defects
Background:
- Preterm infants with congenital heart defects (CHDs) represent a vulnerable population with complex healthcare needs.
- Understanding short-term outcomes, including surgical intervention, survival, and hospitalization duration, is crucial for this group.
Purpose of the Study:
- To evaluate short-term outcomes in preterm infants with CHDs.
- To identify factors influencing surgery, survival, and length of hospital stay in this population.
Main Methods:
- Analysis of data from the Kids' Inpatient Database of the Healthcare Cost and Utilization Project.
- Inclusion of preterm infants (gestational age <37 weeks) admitted within 30 days of birth, excluding those with atrial septal defects.
Main Results:
- Overall survival to discharge was 90.5% among 27,434 preterm infants with CHDs.
- Cardiac surgeries were performed in 12.2% of infants; higher birth weight and specific lesion types were associated with increased likelihood of surgery.
- Factors predicting mortality included low birth weight, nonwhite race, trisomy syndromes, prematurity-related morbidities, and high Risk-adjustment for Congenital Heart Surgery (RACHS) categories.
Conclusions:
- High survival rates suggest a cautiously optimistic surgical approach may be warranted for most preterm infants with CHDs.
- Individualized assessment considering gestational age, birth weight, comorbidities, and defect severity is essential for surgical decision-making.
Objective:
To evaluate short-term outcomes in infants born preterm with congenital heart defects (CHDs) and the factors associated with surgery, survival, and length of hospitalization in this population.
Study Design:
We analyzed data from infants born preterm (gestational age <37 weeks) enrolled in the multicenter Kids' Inpatient Database of the Healthcare Cost and Utilization Project who were admitted to the hospital within 30 days after birth. Infants with atrial septal defects were excluded.
Results:
Of 1 429 762 enrolled infants born preterm, 27 434 (2.0%) with CHDs were included. Overall survival to discharge was 90.5%; 74.0% among infants with critical CHDs and 45.7% among infants with hypoplastic left heart syndrome. Cardiac surgeries were performed in 12.2% of all infants born preterm. Rates of surgical intervention for infants with critical CHDs were lower for very low birth weight (≤1.5 kg) vs larger infants >1.5 kg (27% vs 44%), and only 6.3% of infants born with very low birth weight underwent surgeries in Risk-adjustment for Congenital Heart Surgery categories 4 or greater. Greater birth weight, left-sided lesions, care at children's hospitals, and absence of trisomies were associated with a greater likelihood of surgery. Birth weight <2 kg, nonwhite race, trisomy syndromes, prematurity-related morbidities, and Risk-adjustment for Congenital Heart Surgery category 4 or greater were independent predictors of mortality. Birth weight <2 kg, Risk-adjustment for Congenital Heart Surgery category, morbidities, and sidedness of lesion predicted length of stay.
Conclusions:
The high survival rates of infants born preterm with CHDs suggests that a cautiously optimistic approach to surgery may be warranted in all but the most immature infants with the greatest-risk conditions.
