Abstract TP169: Post-Neonatal Stroke In Children With Critical Congenital Heart Defects

Abstract

Background: Critical congenital heart defects (CCHD) are a subset of mostly cyanotic lesions that require intervention within the first days to weeks of life for survival. For children born with CCHD, the neonatal period is considered the time of highest risk for brain injury as abnormalities in fetal circulation can lead to vulnerabilities in cerebral perfusion prior to corrective cardiac procedures. The prevalence and timing of cerebrovascular events associated with CCHD after the neonatal period is less clear. Methods: We performed a cross-sectional analysis using the National Inpatient Sample database from 2012-2018. We included all children aged 1-18 years hospitalized with either ischemic stroke (IS), intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH). We created multivariable linear and logistic regression models to assess differences in age at stroke onset and mortality after stroke. Results: We identified 4,647 pediatric strokes, 162 (3.5%) of which were associated with CCHD. Adjusting for demographic and clinical covariates, the median age at time of stroke was lower in CCHD patients across all stroke subtypes (Figure). Children with CCHD experienced a higher proportion of IS compared to children without CCHD (75.3% vs 49.5%, P<0.001); and a lower proportion of ICH and SAH (10.5% vs 25.7% and 14.2% vs 24.9%; both P = 0.002). In-hospital mortality for the entire sample following stroke was 10.4% for IS, 14.5% for ICH, and 13.4% for SAH. Adjusting for demographics and confounders, presence of CCHD doubled the odds of death following stroke (OR 2.05; 95% CI 1.35-3.11). Conclusion: Beyond the first year of life, children with CCHD have earlier age at stroke onset and higher post-stroke mortality compared to children without CCHD. Continued vigilance and monitoring of potential neurological complications is warranted in children with CCHD.