Perinatal and perioperative factors associated with mortality and an increased need for hospital care in infants with transposition of the great arteries: A nationwide 11‐year population‐based cohort

Abstract

Introduction: Newborn infants with transposition of the great arteries (d-TGA) need immediate care for an optimal outcome. This study comprised a nationwide 11-year population-based cohort of d-TGA infants, and assessed whether the implementation of a nationwide systematic fetal screening program, or other perinatal, or perioperative factors, are associated with mortality or an increased need for hospital care. Material and methods: The national cohort consisted of all live-born infants with simple d-TGA (TGA ± small ventricular septal defect, n = 127) born in Finland during 2004-2014. Data were collected from six national registries. Prenatal diagnosis and perinatal and perioperative factors associated with mortality and length of hospitalization were evaluated. Results: Preoperative mortality was 7.9%, and the total mortality was 8.7%. The prenatal detection rate increased after introducing systematic fetal anomaly screening from 5.0% to 37.7% during the study period (P < .0001), but the total mortality rate remained unchanged. All prenatally diagnosed infants (n = 27) survived. Lower gestational age (odds ratio 0.68, P = .012) and higher maternal age at birth (odds ratio 1.16, P = .036) were associated with increased mortality in multivariable analysis. Older infant age at time of operation (P = .002), longer aortic clamp time (P < .001), and higher maternal body mass index (P = .027) were associated with longer initial hospital stay. An extended need for hospital care during the first year of life was multi-factorial. Conclusions: In our cohort, none of the prenatally diagnosed d-TGA infants died. As a result of the limited prenatal detection rates, however, the sample size was insufficient to reach statistical significance. The d-TGA infants born with lower gestational age and to older mothers had increased mortality.

Maternal first trimester metabolic profile in pregnancies with transposition of the great arteries

“…From a national cohort of all live‐born infants with simple d‐TGA (TGA ± small ventricular septal defect, n = 127) born in Finland during 2004–2014 (Hautala et al, 2020), we identified live‐born cases for whom register data and Biobank serum samples were available ( n = 100). Each case was matched with two healthy controls ( n = 200) according to the sex of the child, year of birth, and the age and the body mass index (BMI) of the mother as well as Biobank sample availability.…”

Maternal first trimester metabolic profile in TGA pregnancies - a case-control study

“…These screening serum samples collected over the years 1983-2016 (Finnish Maternity Cohort) were deposited at Biobank Borealis if the mother consented to this (15). From a national cohort of all live-born infants with simple d-TGA (TGA +/-small ventricular septal defect, n=127) born in Finland during 2004-2014 (16) , we identified 100 live-born cases and each case was matched with two healthy controls (n=200) whose maternal screening samples were available at Biobank Borealis. The background data was collected from the Medical Birth Register maintained by the Finnish Institute for Health and Welfare.…”

Transposição De Grandes Artérias

“…A realização de um diagnóstico pré-natal possibilita a centralização do parto dos neonatos portadores de TGA em locais com nível de complexidade adequado para o gerenciamento ideal da DCC apresentada (HAUTALA et al, 2020). Assim, o diagnóstico pré-natal da TGA possui benefícios significativos contribuindo para melhores condições de pré-operatório e resultados cirúrgicos.…”