Prematurity and Congenital Heart Disease: A Contemporary Review

Reddy, Reshma K; McVadon, Deani H; Zyblewski, Sinai C.; Rajab, Taufiek Konrad; Diego, Ellen; Southgate, W. Michael; Fogg, Kristi L.; Costello, John M.

doi:10.1542/neo.23-7-e472

Cited by 20 publications

(11 citation statements)

References 102 publications

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“…A total of 91 infants had initial consultation by the multidisciplinary BPD team between 2018 and 2020. Ten patients with critical congenital heart disease (CHD) (Supplementary Table S2), defined as requiring surgery or catheter-based intervention in the first year of life (22), were excluded due to critical CHD being a major risk factor for death in prematurity (23)(24)(25) and the challenges defining whether PH was attributable to premature lung disease or CHD itself. Eleven patients who never had PH on echocardiogram were excluded.…”

Section: Study Cohortmentioning

confidence: 99%

A multidisciplinary approach to severe bronchopulmonary dysplasia is associated with resolution of pulmonary hypertension

et al. 2023

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ObjectiveTo describe our multidisciplinary bronchopulmonary dysplasia (BPD) consult team's systematic approach to BPD associated pulmonary hypertension (PH), to report our center outcomes, and to evaluate clinical associations with outcomes.Study designRetrospective cohort of 60 patients with BPD-PH who were referred to the Seattle Children's Hospital BPD team from 2018 to 2020. Patients with critical congenital heart disease were excluded. Demographics, comorbidities, treatments, closure of hemodynamically relevant intracardiac shunts, and clinical outcomes including time to BPD-PH resolution were reviewed.ResultsMedian gestational age of the 60 patients was 25 weeks (IQR: 24–26). 20% were small for gestational age (SGA), 65% were male, and 25% received a tracheostomy. With aggressive cardiopulmonary management including respiratory support optimization, patent ductus arteriosus (PDA) and atrial septal defect (ASD) closure (40% PDA, 5% ASD, 3% both), and limited use of pulmonary vasodilators (8%), all infants demonstrated resolution of PH during the follow-up period, including three (5%) who later died from non-BPD-PH morbidities. Neither SGA status nor the timing of PH diagnosis (<36 vs. ≥36 weeks PMA) impacted the time to BPD-PH resolution in our cohort [median 72 days (IQR 30.5–166.5)].ConclusionOur multidisciplinary, systematic approach to BPD-PH management was associated with complete resolution of PH with lower mortality despite less sildenafil use than reported in comparable cohorts. Unique features of our approach included aggressive PDA and ASD device closure and rare initiation of sildenafil only after lack of BPD-PH improvement with respiratory support optimization and diagnostic confirmation by cardiac catheterization.

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Section: Study Cohortmentioning

confidence: 99%

A multidisciplinary approach to severe bronchopulmonary dysplasia is associated with resolution of pulmonary hypertension

et al. 2023

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“…Another important CHD‐relevant field is prematurity. Although CHD and prematurity are distinct conditions, neonates with CHD are more likely to be born prematurely, and preterm neonates have increased possibilities of comorbidities with CHD [ 154 ]. CHD infants and premature infants share certain similarities, such as respiratory challenges, extended hospital stays, proinflammatory environment, immature immune system, and intestinal dysbiosis [ 155 ].…”

Section: Discussionmentioning

confidence: 99%

From heart to gut: Exploring the gut microbiome in congenital heart disease

Liu,

Huang,

et al. 2023

iMeta

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Congenital heart disease (CHD) is a prevalent birth defect and a significant contributor to childhood mortality. The major characteristics of CHD include cardiovascular malformations and hemodynamical disorders. However, the impact of CHD extends beyond the circulatory system. Evidence has identified dysbiosis of the gut microbiome in patients with CHD. Chronic hypoxia and inflammation associated with CHD affect the gut microbiome, leading to alterations in its number, abundance, and composition. The gut microbiome, aside from providing essential nutrients, engages in direct interactions with the host immune system and indirect interactions via metabolites. The abnormal gut microbiome or its products can translocate into the bloodstream through an impaired gut barrier, leading to an inflammatory state. Metabolites of the gut microbiome, such as short‐chain fatty acids and trimethylamine N‐oxide, also play important roles in the development, treatment, and prognosis of CHD. This review discusses the role of the gut microbiome in immunity, gut barrier, neurodevelopment, and perioperative period in CHD. By fostering a better understanding of the cross‐talk between CHD and the gut microbiome, this review aims to contribute to improve clinical management and outcomes for CHD patients.

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“…It is also known that associated congenital malformations and chromosomal abnormalities are risk factors for prematurity [ 24 , 25 ], so the lack of antenatal diagnosis and therapeutic abortion for these serious abnormalities led to an increase in the frequency of premature births in our group. We demonstrated that prematurity increases the risk of death by 3.29 times in the case of patients with omphalocele (by 3.62 times in the regression model).…”

Section: Discussionmentioning

confidence: 99%

Current Challenges in the Treatment of the Omphalocele—Experience of a Tertiary Center from Romania

Ţarcă

Cojocaru

Trandafir

et al. 2022

JCM

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Omphalocele is a congenital abdominal wall defect with a constant incidence in recent decades, sometimes representing a real burden for neonatal intensive care units due to prolonged hospitalization and the evolution to death. In our study, we aimed to detect the main risk factors of an unfavorable evolution in the case of omphalocele. Methods: Retrospective cohort study of all neonates with omphalocele treated in our tertiary pediatric hospital during the last three decades; from 158 patients, 139 patients were eligible for the study. We tried to determine the risk of death using logistic regression model. Results: If the neonate develops sepsis, then there is an increased risk (13.03 times) of evolution to death. Similarly, the risk of death is 10.82 times higher in the case of developing acute renal failure, 6.28 times higher in the case of associated abnormalities, 5.54 in the case of developing hemorrhagic disease, and 3.78 in the case of conservative treatment (applied for giant omphalocele or severe chromosomal abnormalities). Prematurity increases by 3.62 times the risk of death. All six independent variables contributed 61.0% to the risk of death. The area under the ROC curve is 0.91, meaning that the diagnostic accuracy of our logistic regression model is very good for predicting the contribution of the six independent variables to the risk of death. Conclusion: Although in the past 30 years we witnessed several improvements in the antenatal diagnosis and management of omphalocele, survival rate remained constant, 47.5% overall. Much effort is still needed to eliminate the risk factors for death in this condition.

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Prematurity and Congenital Heart Disease: A Contemporary Review

Cited by 20 publications

References 102 publications

A multidisciplinary approach to severe bronchopulmonary dysplasia is associated with resolution of pulmonary hypertension

A multidisciplinary approach to severe bronchopulmonary dysplasia is associated with resolution of pulmonary hypertension

From heart to gut: Exploring the gut microbiome in congenital heart disease

Current Challenges in the Treatment of the Omphalocele—Experience of a Tertiary Center from Romania

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