Survival, by Birth Weight and Gestational Age, in Individuals With Congenital Heart Disease: A Population‐Based Study

Abstract

BackgroundCongenital heart disease (CHD) survival estimates are important to understand prognosis and evaluate health and social care needs. Few studies have reported CHD survival estimates according to maternal and fetal characteristics. This study aimed to identify predictors of CHD survival and report conditional survival estimates.Methods and ResultsCases of CHD (n=5070) born during 1985–2003 and notified to the Northern Congenital Abnormality Survey (NorCAS) were matched to national mortality information in 2008. Royston–Parmar regression was performed to identify predictors of survival. Five‐year survival estimates conditional on gestational age at delivery, birth weight, and year of birth were produced for isolated CHD (ie, CHD without extracardiac anomalies). Year of birth, gestational age, birth weight, and extracardiac anomalies were independently associated with mortality (all P≤0.001). Five‐year survival for children born at term (37–41 weeks) in 2003 with average birth weight (within 1 SD of the mean) was 96.3% (95% CI, 95.6–97.0). Survival was most optimistic for high‐birth‐weight children (>1 SD from the mean) born post‐term (≥42 weeks; 97.9%; 95% CI, 96.8–99.1%) and least optimistic for very preterm (<32 weeks) low‐birth‐weight (<1 SD from mean) children (78.8%; 95% CI, 72.8–99.1).ConclusionsFive‐year CHD survival is highly influenced by gestational age and birth weight. For prenatal counseling, conditional survival estimates provide best‐ and worst‐case scenarios, depending on final gestational age and birth weight. For postnatal diagnoses, they can provide parents with more‐accurate predictions based on their baby's birth weight and gestational age.

Socio‐economic inequalities in mortality in children with congenital heart disease: A systematic review and meta‐analysis

“…The following types of mortality were analysed: in‐hospital (n = 10), infant (<1 year, n = 6), neonatal (<28 days, n = 2), postoperative (n = 2), post‐discharge (n = 3), intra‐stage (n = 2), and long‐term (>1 year, n = 6) (see Table for study‐specific definitions). Four measures of SES were reported in the included studies: area‐based poverty (n = 13), parental (maternal or paternal) or area‐based education (n = 9), individual health insurance status (n = 8), and area‐based income (n = 8) . The definitions for SES measures used in individual studies are given in Table .…”

“…The definitions for SES measures used in individual studies are given in Table . The included articles were based on US (n = 22), UK (n = 5), and Panama (n = 1) populations. Most articles included all CHD subtypes combined (n = 21), with the rest including cases of HLH or single ventricle (SV) defects (n = 5), atrioventricular septal defect (AVSD, n = 1), and a composite group of “critical” subtypes (n = 1) .…”

“…The included articles were based on US (n = 22), UK (n = 5), and Panama (n = 1) populations. Most articles included all CHD subtypes combined (n = 21), with the rest including cases of HLH or single ventricle (SV) defects (n = 5), atrioventricular septal defect (AVSD, n = 1), and a composite group of “critical” subtypes (n = 1) . Cases were ascertained from congenital anomaly registers (n = 11), the Kids Inpatient Database (KIDS, n = 4), the SV reconstruction (SVR) trial (n = 2), clinical databases (n = 2), the Paediatric Health Information system (n = 2), medical records, or hospital discharges (n = 7) .…”

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

“…This result was most likely explained by the higher GA at birth in the SGA versus non‐SGA infants. Best and colleagues15 recently published data on long‐term survival estimates in 5093 infants with CHD born between the years 1985 and 2003 in the north of England. They divided the cases into 3 Z score categories and found that infants with Z score <−1 had a higher crude and adjusted hazard ratio for 5‐year mortality than infants with a Z score 1≤ Z ≤1, and infants with a Z score >1 had a slightly lower adjusted hazard ratio.…”

“…To date, the few studies that have evaluated the effect of SGA on mortality in infants with CHD are either relatively small (n=136–308)12, 13, 14 or have examined BW Z score as a dichotomous variable (eg, SGA versus adequate for GA [AGA]). While these studies provide useful information, they potentially missed a more complex relationship between fetal growth and mortality in this patient population 15. None of these studies investigated the potentially differential effect of BW Z score on mortality within GA categories.…”