Survival, Morbidities, and Developmental Outcomes among Low Birth Weight Infants with Congenital Heart Defects

Abstract

Objective Prematurity and low birth weight (LBW) are risk factors for increased morbidity and mortality in infants with congenital heart defects (CHDs). We sought to describe survival, inhospital morbidities, and 2-year neurodevelopmental follow-up in LBW infants with CHD. Study Design We included infants with birth weight (BW) <2,500 g diagnosed with CHD (except isolated patent ductus arteriosus) admitted January 2013 to March 2016 to a single level-IV academic neonatal intensive care unit. We reported CHD prevalence by BW and gestational age; selected in-hospital morbidities and mortality by infant BW, CHD type, and surgical intervention; and developmental outcomes by Bayley's scales of infant and toddler development, third edition (BSID-III) scores at age 2 years. Results Among 420 infants with CHD, 28 (7%) underwent cardiac surgery. Median (25th and 75th percentiles) gestational age was 30 (range: 27–33) weeks and BW was 1,258 (range: 870–1,853) g. There were 134 of 420 (32%) extremely LBW (<1,000 g) infants, 82 of 420 (20%) were small for gestational age, and 51 of 420 (12%) multiples. Most common diagnosis: atrial septal defect (260/420, 62%), followed by congenital anomaly of the pulmonary valve (75/420, 18%). Most common surgical procedure: pulmonary artery banding (5/28, 18%), followed by the tetralogy of Fallot corrective repair (4/28, 14%). Survival to discharge was 88% overall and lower among extremely LBW (<1,000 g, 81%) infants and infants undergoing surgery (79%). Comorbidities were common (35%); retinopathy of prematurity and bronchopulmonary dysplasia were most prevalent. BSID-III scores were available on 148 of 176 (84%); any scores <85 were noted in 73 of 148 (49%), with language being most commonly affected. Conclusion Among LBW infants with congenital heart disease, hospital mortality varied by BW and cardiac diagnosis. Key Points

Prevalence of Congenital Heart Disease in Chinese Children With Different Birth Weights and Its Relationship to the Neonatal Birth Weight

“…We observed that the overall prevalence of CHD was 8.44 per 1,000 live births, and the three subtypes with the highest prevalence of CHD were ASD, VSD, and PFO, which was similar to most of the previous studies (8–10 per 1,000 births at global and local levels) ( 17 – 21 ). The prevalence of CHD in VLBW, LBW, and SGA infants was higher than in other birth weight groups, which was consistent with previous studies ( 2 , 6 – 8 ), but the prevalence varied slightly in different regions; the reasons why heterogeneity of CHD prevalence might be differences in study populations, prenatal detection capability, and ascertainment of criteria. The reasons for the increased frequency of CHD in VLBW and SGA infants are still a matter of speculation ( 22 ), small septal defects may close spontaneously in utero, and therefore fewer may be apparent in term infants ( 7 ).…”

“…CHDs that caused a decrement in birth weight in a descending order of severity are atrial septal defect (721 g/23%), patent ductus arteriosus (669 g/21%), ventricular septal defect (610 g/19%), pulmonary stenosis (548 g/13%), and tetralogy of Fallot (248 g/8%) ( 5 ). In addition, the prevalence of CHD in very premature/VLBW infants is higher than that of general live births, and it is independent of other risk factors and causes death and serious complications ( 6 – 8 ).…”

Newborns with Low Body Weight: Specific Weight, Structure and Dynamics of Incidence

“…Рождение детей с малой массой тела в индустриально развитых странах обусловлено генотипом матери и плода, хронической патологией женщины, особенностями плацентации, осложненным течением беременности, курением, реже -нарушениями питания женщины. В настоящее время большинство исследователей констатируют, что малый вес при рождении является ведущей причиной неблагоприятных перинатальных исходов и тесно связан с неонатальными заболеваемостью, смертностью и выживаемостью [11][12][13][14][15][16]. Доказана ассоциация НМТ при рождении с нарушением физического, моторного и когнитивного развития в последующие периоды детства [17,18].…”