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Survival, Morbidities, and Developmental Outcomes among Low Birth Weight Infants with Congenital Heart Defects
Mihai Puia-Dumitrescu1, Laura N Sullivan2, David Tanaka3
1Department of Pediatrics, University of Washington, Seattle, Washington.
Insights
Survival rates for low birth weight infants with congenital heart defects (CHDs) vary by birth weight and diagnosis. While overall survival improved, nearly half showed developmental delays at two years, particularly in language. This highlights the need for specialized care.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Developmental Pediatrics
Background:
- Prematurity and low birth weight (LBW) are significant risk factors for increased morbidity and mortality in infants diagnosed with congenital heart defects (CHDs).
- Understanding the outcomes of LBW infants with CHDs is crucial for improving clinical management and long-term prognosis.
Purpose of the Study:
- To describe survival rates, in-hospital morbidities, and 2-year neurodevelopmental outcomes in infants with low birth weight (LBW) and congenital heart defects (CHDs).
- To analyze the prevalence of CHD in relation to birth weight and gestational age.
- To identify factors influencing in-hospital morbidities and mortality in this vulnerable population.
Main Methods:
- Retrospective analysis of 420 infants with congenital heart defects (CHD) and birth weight (BW) <2,500g admitted to a level-IV NICU between January 2013 and March 2016.
- Data collected included CHD prevalence by BW and gestational age, in-hospital morbidities, mortality, surgical interventions, and neurodevelopmental outcomes assessed using Bayley's Scales of Infant and Toddler Development, Third Edition (BSID-III) at 2 years.
- Survival rates were analyzed based on BW, CHD type, and surgical status.
Main Results:
- Overall survival to discharge was 88%, but lower in extremely LBW infants (<1,000g) at 81% and those undergoing surgery at 79%.
- Common comorbidities included retinopathy of prematurity and bronchopulmonary dysplasia (35% prevalence).
- At 2 years, 49% of assessed infants had BSID-III scores below 85, with language development being most commonly affected.
Conclusions:
- Hospital mortality in low birth weight (LBW) infants with congenital heart disease (CHD) is influenced by birth weight and specific cardiac diagnoses.
- Overall survival rates in this cohort were higher than previously reported, and morbidities were less frequent than anticipated.
- A significant proportion of LBW infants with CHD experience neurodevelopmental challenges, particularly affecting language, by age 2, underscoring the need for early intervention.
Objective:
Prematurity and low birth weight (LBW) are risk factors for increased morbidity and mortality in infants with congenital heart defects (CHDs). We sought to describe survival, inhospital morbidities, and 2-year neurodevelopmental follow-up in LBW infants with CHD.
Study Design:
We included infants with birth weight (BW) <2,500 g diagnosed with CHD (except isolated patent ductus arteriosus) admitted January 2013 to March 2016 to a single level-IV academic neonatal intensive care unit. We reported CHD prevalence by BW and gestational age; selected in-hospital morbidities and mortality by infant BW, CHD type, and surgical intervention; and developmental outcomes by Bayley's scales of infant and toddler development, third edition (BSID-III) scores at age 2 years.
Results:
Among 420 infants with CHD, 28 (7%) underwent cardiac surgery. Median (25th and 75th percentiles) gestational age was 30 (range: 27-33) weeks and BW was 1,258 (range: 870-1,853) g. There were 134 of 420 (32%) extremely LBW (<1,000 g) infants, 82 of 420 (20%) were small for gestational age, and 51 of 420 (12%) multiples. Most common diagnosis: atrial septal defect (260/420, 62%), followed by congenital anomaly of the pulmonary valve (75/420, 18%). Most common surgical procedure: pulmonary artery banding (5/28, 18%), followed by the tetralogy of Fallot corrective repair (4/28, 14%). Survival to discharge was 88% overall and lower among extremely LBW (<1,000 g, 81%) infants and infants undergoing surgery (79%). Comorbidities were common (35%); retinopathy of prematurity and bronchopulmonary dysplasia were most prevalent. BSID-III scores were available on 148 of 176 (84%); any scores <85 were noted in 73 of 148 (49%), with language being most commonly affected.
Conclusion:
Among LBW infants with congenital heart disease, hospital mortality varied by BW and cardiac diagnosis.
Key Points:
· In low birth weight infants with congenital heart disease, survival varied by birth weight and cardiac diagnosis.. · Overall survival was higher than previously reported.. · There were fewer morbidities than previously reported.. · Bayley's scale-III scores at 2 years of age were <85 for nearly half..
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