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BMC Pediatr. 2017 May 15;17(1):124. doi: 10.1186/s12887-017-0875-z.

Impact of preterm birth on infant mortality for newborns with congenital heart defects: The EPICARD population-based cohort study.

Author information

1
Obstetrical, perinatal and pediatric epidemiology research team, Center for biostatistics and epidemiology, INSERM U1153, Maternité de Port-Royal, 6ème étage, 53 av. de l'Observatoire, 75014, Paris, France.
2
Centre de référence M3C-Necker, Université Paris Descartes, 140 rue de Sèvres, 75015, Paris, France.
3
Service de chirurgie des cardiopathies congénitales, Hôpital Marie Lannelongue, 133, avenue de la Résistance, 92350, Le Plessis Robinson, France.
4
Service de pédiatrie et réanimation néonatales CHU Necker Enfants Malades, Paris, France.
5
Maternité Port Royal, 53 avenue de l'Observatoire, 75014, Paris, France.
6
Obstetrical, perinatal and pediatric epidemiology research team, Center for biostatistics and epidemiology, INSERM U1153, Maternité de Port-Royal, 6ème étage, 53 av. de l'Observatoire, 75014, Paris, France. babak.khoshnood@inserm.fr.

Abstract

BACKGROUND:

Congenital heart defects (CHD) and preterm birth (PTB) are major causes of infant mortality. However, limited data exist on risk of mortality associated with PTB for newborns with CHD. Our objective was to assess impact of PTB on risk of infant mortality for newborns with CHD, while taking into account the role of associated anomalies and other potentially confounding factors.

METHODS:

We used data on 2172 live births from a prospective population-based cohort study of CHD (the EPICARD Study) and compared neonatal, post-neonatal and overall infant mortality for infants born at <32, 32-34 and 35-36 weeks vs. those born at term (37-41 weeks).

RESULTS:

Preterm newborns had a 3.8-fold higher risk of infant death (17.9%) than term newborns (4.7%), RR 3.8, 95%CI 2.7-5.2; the risk associated with PTB was more than four-fold higher for neonatal (RR 4.3, 95% CI 2.9-6.6) and three-fold higher for post-neonatal deaths (RR 3.0, 95% CI 1.7-5.2). Survival analysis showed that newborns <35 weeks had a higher risk of mortality, which decreased but persisted after exclusion of associated anomalies and adjustment for potential confounders.

CONCLUSIONS:

Preterm birth is associated with an approximately four-fold higher risk of infant mortality for newborns with CHD. This excess risk appears to be mostly limited to newborns <35 weeks of gestation and is disproportionately due to early deaths.

KEYWORDS:

Congenital heart defects; Mortality; Preterm birth

PMID:
28506266
PMCID:
PMC5433049
DOI:
10.1186/s12887-017-0875-z
[Indexed for MEDLINE]
Free PMC Article

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