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Association Between Birth Weight Z-Scores and Early Outcomes Following Truncus Arteriosus Repair
Joseph J Stephenson1, Jessica E Hook2, Jonathan Beall3
1Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina College of Medicine, Charleston, USA. Jsteph57@uthsc.edu.
Insights
Fetal growth restriction, indicated by low birth weight Z-scores and being small for gestational age (SGA), is linked to higher mortality in infants after truncus arteriosus (TA) repair. These factors did not significantly impact other early complications or readmissions.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Research
- Neonatal Outcomes
Background:
- Truncus arteriosus (TA) is a complex congenital heart defect requiring surgical repair in infancy.
- Fetal growth restriction is a known risk factor for adverse neonatal outcomes.
- Early outcomes following TA repair are critical for long-term survival and quality of life.
Purpose of the Study:
- To investigate the association between fetal growth restriction, measured by birth weight Z-score and small for gestational age (SGA) status, and early outcomes in infants undergoing truncus arteriosus (TA) repair.
- To identify specific risk factors influencing mortality and morbidity after TA repair.
Main Methods:
- Retrospective analysis of the Pediatric Health Information System (PHIS) database from 2004 to 2019.
- Inclusion of infants under 90 days old who underwent TA repair.
- Utilized generalized estimating equation (GEE) models to assess associations between birth weight Z-score, SGA status, and outcomes, adjusting for relevant variables. A total of 1039 infants were included.
Main Results:
- Lower birth weight Z-scores were significantly associated with increased hospital mortality (adjusted OR 1.71 for each unit decrease below -1.0).
- Small for gestational age (SGA) status was also significantly associated with higher hospital mortality (adjusted OR 2.17).
- No significant associations were found between birth weight Z-scores or SGA status and other outcomes like cardiac arrest, ECMO use, prolonged LOS, or readmission.
Conclusions:
- Fetal growth restriction, evidenced by low birth weight Z-scores and SGA, is a significant predictor of increased hospital mortality in infants undergoing truncus arteriosus (TA) repair.
- These growth parameters do not appear to be associated with other major early postoperative complications or readmission rates.
- Risk stratification for infants undergoing TA repair should consider fetal growth parameters to anticipate potential mortality risks.
Abstract:
In infants undergoing truncus arteriosus (TA) repair, we sought to determine associations between fetal growth restrictions as measured by birth weight Z-score and early outcomes. We utilized the Pediatric Health Information System (PHIS) database to identify infants < 90 days old who underwent TA repair from 2004 to 2019. The primary exposure variable was birth weight Z-score, calculated based on gestational age at birth, gender, and birth weight. The primary outcome was postoperative hospital mortality. Secondary outcomes included major complications, prolonged postoperative length of hospital stay (LOS; > 30 days), and hospital readmission within 1 year. Generalized estimating equation (GEE) models were used to identify adjusted associations between birth weight Z-score, small for gestational age (SGA) status, and mortality and included were 1039 subjects. Median birth weight was 2960 g, gestational age at birth was 38 weeks, and birth weight Z-score was - 0.47. SGA was present in 21% of subjects. Hospital mortality occurred in 104 patients (10%). By multivariable analysis, lower birth weight Z-score was associated with higher hospital mortality [for each unit decrease in birth weight Z-score below - 1.0, adjusted OR 1.71 (95% CI 1.10-4.25)]. SGA status was associated with increased hospital mortality (adjusted OR 2.17; 95% CI 1.39-3.40). Birth weight Z-scores and SGA status were not significantly associated with occurrence of cardiac arrest, ECMO use, gastrostomy tube placement, tracheostomy, seizures, infection, prolonged postoperative LOS, or hospital readmission. In infants undergoing TA repair, lower birth weight Z-scores and SGA status were strongly associated with increased hospital mortality.
