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Neonatal Ebstein anomaly national outcomes from 2000 to 2018 using the National Inpatient Sample
Allison M Peluso1, Hasan F Othman2, Kenneth Zahka3
1Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio, USA.
Insights
Ebstein anomaly (EA) in neonates is rare but has high mortality, especially without surgical repair. Its prevalence remained stable, unlike other critical congenital heart defects (CCHD).
Area of Science:
- Pediatric Cardiology
- Neonatal Health
- Congenital Heart Disease Research
Background:
- Ebstein anomaly (EA) is a rare congenital heart disease (CHD) with poorly understood prevalence, morbidity, and mortality in neonates.
- EA exhibits significant heterogeneity, complicating its characterization in the neonatal population.
Purpose of the Study:
- To determine the recent prevalence, mortality, outcomes, and healthcare utilization of neonates with EA (≤28 days of life) from 2000-2018.
- To compare these metrics for EA against other critical congenital heart defects (CCHD) in the United States.
Main Methods:
- Utilized the National Inpatient Sample (NIS) database from 2000-2018.
- Identified neonates (≤28 days) with EA using ICD-9 and 10 codes.
- Compared EA patient characteristics, morbidity, mortality, and healthcare utilization with other CCHDs.
Main Results:
- Identified 4,398 neonates with isolated EA, representing 7 per 100,000 admissions and 2.2% of CCHD admissions.
- In-hospital mortality for EA was 12.3%, with 86.6% of deaths occurring in non-surgically repaired infants.
- Arrhythmias affected 10.6% and ECMO was used in 2.6% of neonates with EA.
Conclusions:
- Ebstein anomaly (EA) prevalence remained stable, contrasting with increasing rates of other CHDs.
- Neonatal mortality for EA was significantly higher than for pooled CCHDs.
- Surgical intervention is critical, as the majority of mortality in neonates with EA occurred without it.
Background:
The prevalence, morbidity, and mortality associated with Ebstein anomaly (EA) remains poorly characterized in neonates. EA is a rare form of congenital heart disease (CHD) with significant heterogeneity.
Objective:
To determine the recent, 2000-2018, prevalence, mortality, outcomes, and healthcare utilization of infants admitted at ≤28 days of life with EA in comparison to other critical congenital heart defects (CCHD) in the United States using a national data set.
Methods:
The National Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP) was queried for infants admitted for any reason at ≤28 days of life with a diagnosis of EA between 2000 and 2018 using ICD-9 and 10 codes in the United States. Patient characteristics, morbidity, mortality, and healthcare utilization were evaluated for EA and compared with other CCHD.
Results:
From 2000 to 2018 a total of 68,312,952 neonatal admissions were identified, of them 4,398 neonates with isolated EA were identified, representing 7 per 100,000 neonatal admissions and 2.2% of CCHD admissions (4,398/197,881). The number of new EA cases ranged from 138 to 375 per year. In-hospital mortality was 12.3% and surgical repair occurred in 4.2% for infants with EA. There were 470 deaths without surgical repair which is 86.6% of the mortality. Arrhythmias were diagnosed in 10.6% and ECMO was used for 2.6% of neonates with EA.
Conclusion:
EA is a rare form of CHD. The prevalence has remained stable over the 19 years whereas other congenital heart defects have had an increase. The mortality in neonates with EA was significantly higher than in pooled CCHD; the burden of mortality occurred in the neonates without surgical intervention.
