Mortality and morbidity in preterm infants with congenital heart disease

Biris, Ioana Dumitrascu; Mintoft, Alison; Harris, Christopher; Rawn, Zeshan; Jheeta, Jatinder S; Pushparajah, Kuberan; Khan, Hammad; Fox, Grenville

doi:10.1111/apa.16155

Cited by 6 publications

(4 citation statements)

References 28 publications

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“…Preterm infants with CHD were reported to experience a wide extent and mostly mild forms of IVH [all the above]. Others reported a lower risk of IVH in preterm infants with CHD compared to controls ( 9 ). In the current analysis, the presence of severe CHD in premature infants was associated with a 6-fold increase in the risk of developing severe IVH.…”

Section: Discussionmentioning

confidence: 99%

“…Having a congenital heart defect raises the risk of premature birth by 2-to-3 fold compared to neonates without CHD ( 6 – 8 ). It is well-known that severe CHDs are associated with higher mortality rates in full-term infants ( 6 – 9 ).…”

Section: Introductionmentioning

confidence: 99%

“…Despite the significant association between prematurity and CHD, less is known about the impact of GA on outcomes in patients with severe CHD. The few studies that examined the outcomes of premature infants with CHD carried significant limitations including relatively small numbers of premature infants, older birth cohorts (before 2005), excluded extreme preterm or moderate/late preterm infants, or did not account for important confounders such as GA, birth weight (BW), and gender ( 1 , 3 , 6 – 9 ). Moreover, the inclusion of mixed forms of CHDs including minor ones, and the substantial number of patients with non-cardiac anomalies and genetic syndromes might have contributed to the significant variations in the rates of adverse outcomes reported ( 3 , 10 , 11 ).…”

Section: Introductionmentioning

confidence: 99%

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Neonatal outcomes in preterm infants with severe congenital heart disease: a national cohort analysis

Aly,

Qattea,

Kattea

et al. 2024

Front. Pediatr.

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BackgroundPrematurity and congenital heart disease (CHD) are the leading causes of neonatal mortality and morbidity. Limited data are available about the outcomes of premature infants with severe CHD.MethodsWe queried The National Inpatient Database using ICD-10 codes for premature patients (<37 weeks) with severe CHD from 2016 to 2020. Severe CHDs were grouped into three categories: A. left-sided lesions with impaired systemic output, B. Cyanotic CHD, and C. Shunt lesions with pulmonary overcirculation. Patients with isolated atrial or ventricular septal defects and patent ductus arteriosus were excluded. We also excluded patients with chromosomal abnormalities and major congenital anomalies. Patients' demographics, clinical characteristics, and outcomes were evaluated by comparing premature infants with vs. without CHD adjusting for gestational age (GA), birth weight, and gender.ResultsA total of 27710 (1.5%) out of 1,798,245 premature infants had severe CHD. This included 27%, 58%, and 15% in groups A, B, and C respectively. The incidence of severe CHD was highest between 25 and 28 weeks of gestation and decreased significantly with increasing GA up to 36 weeks (p < 0.001). Premature infants with severe CHD had a significantly higher incidence of neonatal morbidities including necrotizing enterocolitis (NEC) [OR = 4.88 (4.51–5.27)], interventricular hemorrhage [OR = 6.22 (5.57–6.95)], periventricular leukomalacia [OR = 3.21 (2.84–3.64)] and bronchopulmonary dysplasia [OR = 8.26 (7.50–10.06) compared to preterm infants of similar GA without CHD. Shunt lesions had the highest incidence of NEC (8.5%) compared to 5.3% in cyanotic CHD and 3.7% in left-sided lesions (p < 0.001). Mortality was significantly higher in premature infants with CHD compared to control [11.6% vs. 2.5%, p < 0.001]. Shunt lesions had significantly higher mortality (11.0%) compared to those with left-sided lesions (8.3%) and cyanotic CHD (6.4%), p < 0.001.ConclusionPremature infants with severe CHD are at high risk of neonatal morbidity and mortality. Morbidity remains increased across all GA groups and in all CHD categories. This significant risk of adverse outcomes is important to acknowledge when managing this patient population and when counseling their families. Future research is needed to examine the impact of specific rather than categorized congenital heart defects on neonatal outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Neonatal outcomes in preterm infants with severe congenital heart disease: a national cohort analysis

Aly,

Qattea,

Kattea

et al. 2024

Front. Pediatr.

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“…Congenital heart disease refers to the abnormality of the heart caused by abnormal embryonic heart development, and it is a major cause of neonatal morbidity and mortality. − Minimally invasive interventional cardiac occluders offer a number of advantages, such as less trauma, simple operation, and postoperative adjustment, − which have gradually become a mainstream treatment method. However, interventional occlusion also has many problems after implantation, such as endothelial injury, coagulation risk, and severe inflammatory response. − These problems limit the in vivo restorative effect of occluders, and it is important to upgrade the occluders to enhance their performance.…”

Section: Introductionmentioning

confidence: 99%

Polyphenol-Reinforced Glycocalyx-Like Hydrogel Coating Induced Myocardial Regeneration and Immunomodulation

Wan,

Yang,

Zhang

et al. 2024

ACS Nano

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Although minimally invasive interventional occluders can effectively seal heart defect tissue, they still have some limitations, including poor endothelial healing, intense inflammatory response, and thrombosis formation. Herein, a polyphenol-reinforced medicine/peptide glycocalyx-like coating was prepared on cardiac occluders. A coating consisting of carboxylated chitosan, epigallocatechin-3-gallate (EGCG), tanshinone IIA sulfonic sodium (TSS), and hyaluronic acid grafted with 3-aminophenylboronic acid was prepared. Subsequently, the mercaptopropionic acid-GGGGG-Arg-Glu-Asp-Val peptide was grafted by the thiol−ene "click" reaction. The coating showed good hydrophilicity and free radical-scavenging ability and could release EGCG−TSS. The results of biological experiments suggested that the coating could reduce thrombosis by promoting endothelialization, and promote myocardial repair by regulating the inflammatory response. The functions of regulating cardiomyocyte apoptosis and metabolism were confirmed, and the inflammatory regulatory functions of the coating were mainly dependent on the NF-kappa B and TNF signaling pathway.

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Cardiogenic Necrotizing Enterocolitis in Infants with Congenital Heart Disease: A Systematic Review and Meta-analysis

Asztalos,

Hill,

Nash

et al. 2024

Pediatr Cardiol

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Necrotizing enterocolitis (NEC) is a known cause of morbidity and mortality in infants with congenital heart disease (CHD), but reports about the burden of cardiogenic NEC frequently conflict. To synthesize the extant literature on the incidence, risk factors, and prognosis of NEC in patients with CHD. Medline, Cochrane, and EMBASE were searched from 1946 through 2023 for studies of NEC in infants 0–12 months of age with CHD. Risk of bias was assessed with validated tools for incidence and risk factors. Pooled estimates were meta-analyzed by risk of bias or synthesized without meta-analysis. Eighty-six studies with a total of 67,924 participants were included. The incidence of cardiogenic NEC was 7.1% (95% CI 4.7–10.5%) in term infants and 13.0% (10.2–16.5%) in low birthweight preterm infants. NEC required surgery in 0.8% (0.5–1.1%) of term and 2.7% (2.0–3.7%) of premature infants, respectively. Only gestational age and birth weight were consistently associated with risk of NEC. Restricting pooled estimates to studies of moderate or low risk of bias significantly reduced the number of studies included. Necrotizing enterocolitis is a common cause of morbidity in infants with CHD, but additional research is needed to determine which infants are at highest risk of developing NEC and would benefit most from a change in management. This systematic review and meta-analysis was conducted according to a prespecified protocol registered at the Prospective Register of Systematic Reviews (CRD42021282114).

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Mortality and morbidity in preterm infants with congenital heart disease

Cited by 6 publications

References 28 publications

Neonatal outcomes in preterm infants with severe congenital heart disease: a national cohort analysis

Neonatal outcomes in preterm infants with severe congenital heart disease: a national cohort analysis

Polyphenol-Reinforced Glycocalyx-Like Hydrogel Coating Induced Myocardial Regeneration and Immunomodulation

Cardiogenic Necrotizing Enterocolitis in Infants with Congenital Heart Disease: A Systematic Review and Meta-analysis

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