Outcome of Extremely Preterm Infants (&lt;1,000 g) With Congenital Heart Defects From the National Institute of Child Health and Human Development Neonatal Research Network

Pappas, Athina; Shankaran, Seetha; Hansen, Nellie I.; Bell, Edward F.; Stoll, Barbara J.; Laptook, Abbot R.; Walsh, Michele C.; Das, Abhik; Bara, Rebecca; Hale, Ellen C.; Newman, Nancy S.; Boghossian, Nansi S.; Murray, Jeffrey C.; Cotten, C. Michael; Adams‐Chapman, Ira; Hamrick, Shannon E. G.; Higgins, Rosemary D.

doi:10.1007/s00246-012-0375-8

Cited by 51 publications

(42 citation statements)

References 25 publications

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“…Major CHD was more common in our cohort of VLBW infants compared with the general population, but lower than in prior VLBW studies [2,6,7]. The overall proportion of VLBW infants with major CHD in our cohort was 299/105,539 (0.3%) and remained unchanged for the duration of the study.…”

Section: Discussioncontrasting

confidence: 55%

“…Mortality in VLBW infants with major CHD is high, but previous studies were limited by inclusion of infants with isolated atrial septal defect (ASD) or ventricular septal defect (VSD), missing information on neonatal morbidities, or inability to examine trends in mortality over time [2,6,7]. The pathophysiologic mechanisms responsible for higher mortality of VLBW infants with congenital heart defects are unknown, but comorbidities associated with the need for surgical intervention and prolonged hospitalization likely play a significant role.…”

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes in very low birth weight infants with major congenital heart defects

Anderson¹,

Smith²,

Corey³

et al. 2014

Early Human Development

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Background The combination of major congenital heart disease (CHD) and prematurity is associated with poor prognosis, but previous studies have not fully characterized morbidity and mortality in this population. We conducted a retrospective cohort study of very low birth weight (VLBW) infants with major CHD to describe outcomes, including mortality, over time. Methods We included all infants <1500 g birth weight with major CHD discharged from Pediatrix Medical Group neonatal intensive care units from 1997–2012. We report incidences of major CHD in VLBW infants and compare mortality and morbidity by infant birth weight, type of major CHD, and time period. Results Of 105,539 VLBW infants, 299 (0.3%) were diagnosed with 15 different major CHDs. Coarctation of the aorta (n=67, 22%), atrioventricular septal defect (n=58, 19%), and tetralogy of Fallot (n=53, 18%) were the most common major CHDs identified. Overall mortality was 163/299 (55%). Mortality was ≥70% for 10 lesions and <30% for isolated aortic valve stenosis (6/30, 20%). Mortality in infants with major CHD did not significantly change over time: 76/133 (57%) in 1997–2005, 49/95 (52%) in 2006–2009, and 38/71 (54%) in 2010–2012 (p=0.70). The majority of infants suffered ≥1 comorbidity or died (218/299, 73%). Conclusion Major CHD is associated with high morbidity and mortality. While mortality varies by lesion, overall survival and incidence of major morbidity have not improved over time.

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Section: Discussioncontrasting

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Clinical outcomes in very low birth weight infants with major congenital heart defects

Anderson¹,

Smith²,

Corey³

et al. 2014

Early Human Development

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“…41,42 Poor fetal growth increases the morbidity and mortality of infants with BDs. 43 The outcomes and survival of infants with CHDs is significantly worse for those born preterm, particularly at earlier gestational ages. 43 The neonatal course and long-term outcomes of infants with BDs requiring surgeries and lengthy hospitalizations are complicated by low birth weight.…”

Section: Discussionmentioning

confidence: 99%

“…43 The outcomes and survival of infants with CHDs is significantly worse for those born preterm, particularly at earlier gestational ages. 43 The neonatal course and long-term outcomes of infants with BDs requiring surgeries and lengthy hospitalizations are complicated by low birth weight. At 18 to 22 months' corrected age, infants with extremely low birth weight and congenital anomalies are at a significantly higher risk of poor growth, requiring in-hospital care and neurodevelopmental impairment than those extremely low birth weight infants without anomalies.…”

Section: Discussionmentioning

confidence: 99%

A spectrum project: preterm birth and small-for-gestational age among infants with birth defects

et al. 2014

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OBJECTIVE: The aim of this study is to investigate the association between birth defects (BDs), prematurity and small-forgestational age (SGA) in a population-based sample. STUDY DESIGN: Participants were singleton live births enrolled in the National Birth Defects Prevention Study, including 18 737 case infants with one or more BD and 7999 controls. Logistic regression models to evaluate associations between BDs, prematurity and fetal growth were computed while adjusting for covariates. RESULT: Cases were significantly more likely to be born prematurely than controls, particularly at 24 to 28 weeks of gestation. The highest odds ratios for preterm birth were found for intestinal atresia, anencephaly, gastroschisis and esophageal atresia. Infants with BDs were also significantly more likely to be SGA than controls (17.2 and 7.8%). CONCLUSION: Infants with BDs are more likely than controls to be born prematurely and SGA. Findings from this study present additional evidence demonstrating a complex interaction between the development of BDs, prematurity and intrauterine growth.

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“…Management of these infants is challenging due to neonatal comorbidities such as BPD, and inability to intervene surgically due to small size. Pappas et al 22 reported an increased risk of growth impairment and neurodevelopmental impairment among ELBW survivors with congenital heart defects. It will be important to monitor mortality trends in VLBW infants with congenital heart defects over time and morbidity among survivors.…”

Section: Types Of Birth Defectsmentioning

confidence: 99%

Ten-Year Review of Major Birth Defects in VLBW Infants

et al. 2013

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OBJECTIVE: Birth defects (BDs) are an important cause of infant mortality and disproportionately occur among low birth weight infants. We determined the prevalence of BDs in a cohort of very low birth weight (VLBW) infants cared for at the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NRN) centers over a 10-year period and examined the relationship between anomalies, neonatal outcomes, and surgical care. METHODS: Infant and maternal data were collected prospectively for infants weighing 401 to 1500 g at NRN sites between January 1, 1998, and December 31, 2007. Poisson regression models were used to compare risk of outcomes for infants with versus without BDs while adjusting for gestational age and other characteristics. RESULTS: A BD was present in 1776 (4.8%) of the 37 262 infants in our VLBW cohort. Yearly prevalence of BDs increased from 4.0% of infants born in 1998 to 5.6% in 2007, P < .001. Mean gestational age overall was 28 weeks, and mean birth weight was 1007 g. Infants with BDs were more mature but more likely to be small for gestational age compared with infants without BDs. Chromosomal and cardiovascular anomalies were most frequent with each occurring in 20% of affected infants. Mortality was higher among infants with BDs (49% vs 18%; adjusted relative risk: 3.66 [95% confidence interval: 3.41–3.92]; P < .001) and varied by diagnosis. Among those surviving >3 days, more infants with BDs underwent major surgery (48% vs 13%, P < .001). CONCLUSIONS: Prevalence of BDs increased during the 10 years studied. BDs remain an important cause of neonatal morbidity and mortality among VLBW infants.

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Outcome of Extremely Preterm Infants (<1,000 g) With Congenital Heart Defects From the National Institute of Child Health and Human Development Neonatal Research Network

Cited by 51 publications

References 25 publications

Clinical outcomes in very low birth weight infants with major congenital heart defects

Clinical outcomes in very low birth weight infants with major congenital heart defects

A spectrum project: preterm birth and small-for-gestational age among infants with birth defects

Ten-Year Review of Major Birth Defects in VLBW Infants

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