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Children Born with Congenital Heart Defects and Growth Restriction at Birth: A Systematic Review and Meta-Analysis
Ali Ghanchi1,2, Neil Derridj1,3, Damien Bonnet3
1Université de Paris, CRESS, INSERM, INRA, F-75004 Paris, France.
Insights
Newborns with congenital heart defects (CHD) are twice as likely to be small for gestational age (SGA). This systematic review quantifies SGA in CHD, highlighting variations across defect types and suggesting diverse underlying causes for growth restriction.
Area of Science:
- Pediatrics
- Cardiology
- Neonatology
Background:
- Congenital heart defects (CHD) are associated with increased risk of growth restriction.
- Growth restriction, often proxied by small for gestational age (SGA) status, is an independent risk factor for adverse outcomes in newborns.
- A comprehensive systematic review on the relationship between CHD and SGA has been lacking.
Purpose of the Study:
- To systematically review and meta-analyze the available literature.
- To estimate the pooled proportion of newborns with CHD who are small for gestational age (SGA).
Main Methods:
- Systematic search of Pubmed and Embase databases up to March 31, 2019.
- Screening and data extraction by two independent reviewers.
- Meta-analysis using a random effects model on data from 18 relevant studies.
Main Results:
- The pooled proportion of SGA in all newborns with CHD was 20% (95% CI 16%-24%).
- For isolated CHD, the pooled SGA proportion was 14% (95% CI 13%-16%).
- SGA proportions varied significantly by CHD subtype, from 30% in Tetralogy of Fallot to 12% in isolated atrial septal defect.
Conclusions:
- Newborns with CHD have a 2-fold higher proportion of SGA compared to the general population.
- Isolated CHD cases showed a 1.4-fold higher SGA proportion.
- Variability in SGA across CHD subtypes suggests diverse pathophysiological mechanisms contributing to growth restriction.
Abstract:
Newborns with congenital heart defects tend to have a higher risk of growth restriction, which can be an independent risk factor for adverse outcomes. To date, a systematic review of the relation between congenital heart defects (CHD) and growth restriction at birth, most commonly estimated by its imperfect proxy small for gestational age (SGA), has not been conducted.
Objective:
To conduct a systematic review and meta-analysis to estimate the proportion of children born with CHD that are small for gestational age (SGA).
Methods:
The search was carried out from inception until 31 March 2019 on Pubmed and Embase databases. Studies were screened and selected by two independent reviewers who used a predetermined data extraction form to obtain data from studies. Bias was assessed using the Critical Appraisal Skills Programme (CASP) checklist. The database search identified 1783 potentially relevant publications, of which 38 studies were found to be relevant to the study question. A total of 18 studies contained sufficient data for a meta-analysis, which was done using a random effects model.
Results:
The pooled proportion of SGA in all CHD was 20% (95% CI 16%-24%) and 14% (95% CI 13%-16%) for isolated CHD. Proportion of SGA varied across different CHD ranging from 30% (95% CI 24%-37%) for Tetralogy of Fallot to 12% (95% CI 7%-18%) for isolated atrial septal defect. The majority of studies included in the meta-analysis were population-based studies published after 2010.
Conclusion:
The overall proportion of SGA in all CHD was 2-fold higher whereas for isolated CHD, 1.4-fold higher than the expected proportion in the general population. Although few studies have looked at SGA for different subtypes of CHD, the observed variability of SGA by subtypes suggests that growth restriction at birth in CHD may be due to different pathophysiological mechanisms.
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