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Published on: July 18, 2014
Double Jeopardy: A Distinct Mortality Pattern Among Preterm Infants with Congenital Heart Disease
Brennan V Higgins1, Philip T Levy2, Molly K Ball3
1Department of Pediatrics, University of California San Francisco, 550 16th Street, 5th Floor, San Francisco, CA, 94143, USA.
Insights
Preterm infants with cyanotic congenital heart disease (CCHD) have significantly lower survival rates and higher early mortality compared to those without CCHD. This highlights a critical need for improved neonatal intensive care for this vulnerable population.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Public Health Surveillance
Background:
- Congenital heart disease (CHD) is common in preterm infants, yet contemporary US survival data are lacking.
- Improving surgical outcomes necessitate updated survival data for preterm infants with CHD.
- Preterm infants are over-represented in the CHD population.
Purpose of the Study:
- To compare 1-year survival and early mortality in US preterm infants with and without cyanotic CHD (CCHD).
- To analyze survival by gestational age (GA) in preterm infants with CCHD.
- To identify trends in survival for preterm infants with CCHD.
Main Methods:
- National retrospective cohort study using US birth and death certificate data (2014-2019).
- Inclusion of liveborn preterm infants (21-36 weeks GA) with and without CCHD (n=2,654,253).
- Analysis of 1-year survival and early mortality (<3 days) stratified by GA and CCHD status.
Main Results:
- Infants with CCHD (0.13% of preterm births) had significantly lower 1-year survival across gestational ages (23-36 weeks).
- The largest survival gap was observed between 28-31 weeks GA.
- Early mortality (<3 days) exceeded 50% for infants with CCHD aged 23-31 weeks.
Conclusions:
- The mortality pattern for preterm infants with CCHD differs significantly from those without.
- A substantial survival gap exists in very preterm infants with CCHD, demanding attention.
- High early mortality rates underscore the need for enhanced neonatal intensive care for preterm infants with CCHD.
Abstract:
Contemporary United States (US) data on the survival of preterm infants with congenital heart disease (CHD) are unavailable despite the over-representation of CHD and improving surgical outcomes in the preterm population. The aim of this study is to use population-based data to compare 1-year survival and early mortality (< 3 days) by gestational age (GA) between preterm infants with and without cyanotic CHD (CCHD) in the US. This national retrospective cohort included all liveborn, preterm infants between 21 and 36 weeks GA with a birth certificate indicating the presence or absence of CCHD (n = 2,654,253) born between 2014 and 2019 in the US. Data were provided by the US Center for Disease Control database linking birth and death certificates. Of liveborn preterm infants, 0.13% (n = 3619) had CCHD. 1-year survival was significantly lower in infants 23-36 weeks with CCHD compared to those without. The greatest survival gap occurred between 28 and 31 weeks (28 weeks adjusted risk difference 37.5%; 95% CI 28.4, 46.5; 31 weeks 37.9%; 30.5, 45.3). Early mortality accounted for more than half of deaths among infants 23-31 weeks with CCHD (23 weeks-68%, CI 46.7, 83.7; 31 weeks-63.9%, 52.9, 73.6). Survival trends demonstrated worsened 1-year survival in infants 35-36 weeks with CCHD over the study period. The pattern of mortality for preterm infants with CCHD is distinct from those without. The significant survival gap in the very preterm population and notably high rate of early death in the infants with CCHD calls for renewed attention to early neonatal intensive care for this dually affected population.
