Effect of Fetal Growth on 1‐Year Mortality in Neonates With Critical Congenital Heart Disease

Abstract

BackgroundInfants with critical congenital heart disease (CCHD) are more likely to be small for gestational age (GA). It is unclear how this affects mortality. The authors investigated the effect of birth weight Z score on 1‐year mortality separately in preterm (GA <37 weeks), early‐term (GA 37–38 weeks), and full‐term (GA 39–42 weeks) infants with CCHD.Methods and ResultsLive‐born infants with CCHD and GA 22 to 42 weeks born in California 2007–2012 were included in the analysis. The primary predictor was Z score for birth weight and the primary outcome was 1‐year mortality. Multivariable logistic regression was used. Results are presented as adjusted odds ratios and 95% confidence intervals (CIs). The authors identified 6903 infants with CCHD. For preterm and full‐term infants, only a Z score for birth weight <−2 was associated with increased mortality compared with the reference group (Z score 0–0.5, adjusted odds ratio, 2.15 [95% CI, 1.1–4.21] and adjusted odds ratio, 3.93 [95% CI, 2.32–6.68], respectively). In contrast, in early‐term infants, the adjusted odds ratios for Z scores <−2, −2 to −1, and −1 to −0.5 were 3.42 (95% CI, 1.93–6.04), 1.78 (95% CI, 1.12–2.83), and 2.03 (95% CI, 1.27–3.23), respectively, versus the reference group.Conclusions GA seems to modify the effect of birth weight Z score on mortality in infants with CCHD. In preterm and full‐term infants, only the most severe small‐for‐GA infants (Z score <−2) were at increased risk for mortality, while, in early‐term infants, the risk extended to mild to moderate small‐for‐GA infants (Z score <−0.5). This information helps to identify high‐risk infants and is useful for surgical planning.

Detecting Critical Congenital Heart Disease in Nevada

“…Between January 2016 and May 2019, there were approximately 121,500 live births in Nevada for a CCHD prevalence of 1.8/1,000 live births, consistent with the literature. 12 Of the 121,500 live births, approximately 42,500 (35%) were Hispanic. There was no statically significant difference in the overall prevalence of CCHD for Hispanics versus non-Hispanics other than isolated total anomalous pulmonary venous return (TAPVR).…”

Association between Z-score for birth weight and postoperative outcomes in neonates and infants with congenital heart disease

“…Our findings mirror those of the population-based California cohort study. 22 In the current study, there was a significant interaction between GA and birth weight Z-score, strongest in early-term infants and weakest in preterm infants. A…”

“…Another study from our group included infants born between 2007 and 2012 in California (n ¼ 6903). 22 The Z-score was modeled as a categorical variable similar to the current study. In this study, the association between birth weight Z-score and 1-year mortality differed between GA categories: in preterm and full-term infants, only the most growth restricted babies (birth weight Z-score<À2) were at increased risk for mortality, whereas in early-term infants, the risk extended to those who were less growth restricted (birth weight Z-score < À0.5).…”

Low Birth Weight and Congenital Heart Disease: Current Status and Future Directions

“…That being said, the interplay between birth weight, gestational age, and in utero growth is quite complex. 9,10 Despite these limitations, the findings of this study offer hope that neonatal operative outcomes are gradually improving for this very fragile patient population. Opportunity for improvement continues to exist, and given the magnitude of the problem, a multifaceted approach is needed.…”