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J Am Heart Assoc. 2020 Mar 3;9(5):e015369. doi: 10.1161/JAHA.119.015369. Epub 2020 Feb 21.

Neonatal Outcomes in Very Preterm Infants With Severe Congenital Heart Defects: An International Cohort Study.

Collaborators (351)

Lui K, Marshall P, Schmidt P, Dhawan A, Craven P, de Waal K, Simmer K, Gill A, Pillow J, Stack J, Birch P, Cooke L, Casalaz D, Holberton J, Stewart A, Downe L, Stewart M, Bajuk B, Berry A, Hunt R, Kilburn C, De Paoli T, Lui K, Bolisetty S, Paradisis M, Rieger I, Koorts P, Kuschel C, Doyle L, Numa A, Carlisle H, Badawi N, Loughran-Fowlds A, Koh G, Davis J, Luig M, Andersen C, Chambers G, Austin N, Lynn A, Darlow B, Edmonds L, Mildenhall L, Buksh M, Battin M, van den Boom J, Bourchier D, Richardson V, Dineen F, Rajadurai VS, Lam S, Fung G, Shah PS, Harrison A, Synnes A, Ting J, Cieslak Z, Sherlock R, Yee W, Aziz K, Toye J, Fajardo C, Kalapesi Z, Sankaran K, Daspal S, Seshia M, Alvaro R, Mukerji A, Da Silva O, Nwaesei C, Lee KS, Dunn M, Lemyre B, Dow K, Pelausa E, Barrington K, Drolet C, Piedboeuf B, Claveau M, Beltempo M, Bertelle V, Masse E, Canning R, Makary H, Ojah C, Monterrosa L, Deshpandey A, Afifi J, Kajetanowicz A, Lee SK, Andersson S, Lehtonen L, Tammela O, Sankilampi U, Saarela T, Heymann E, Zangen S, Smolkin T, Mimouni F, Bader D, Rothschild A, Strauss Z, Felszer C, Omari H, Tov-Friedman SE, Bar-Oz B, Feldman M, Saad N, Flidel-Rimon O, Weisbrod M, Lubin D, Litmanovitz I, Kugelman A, Shinwell E, Klinger G, Nijim Y, Bin-Nun A, Golan A, Mandel D, Fleisher-Sheffer V, Kohelet D, Bakhrakh L, Hattori S, Shirai M, Ishioka T, Mori T, Amizuka T, Huchimukai T, Yoshida H, Sasaki A, Shimizu J, Nakamura T, Maruyama M, Matsumoto H, Hosokawa S, Taki A, Nakagawa M, Ko K, Uozumi A, Nakata S, Shimazaki A, Yoda T, Numata O, Imamura H, Kobayashi A, Tokuriki S, Uchida Y, Arai T, Ito M, Ieda K, Ono T, Hayashi M, Maki K, Yamakawa M, Kawai M, Fujii N, Shiomi K, Nozaki K, Wada H, Kim T, Tokunaga Y, Takatera A, Oshima T, Sumida H, Michinomae Y, Kusumoto Y, Yoshimoto S, Morisawa T, Ohashi T, Takahashi Y, Sugimoto M, Ono N, Miyagawa S, Saijo T, Yamagami T, Koyano K, Kobayashi S, Kanda T, Sakemi Y, Aoki M, Iida K, Goshi M, Maruyama Y, Avila-Alvarez A, Fernandez-Trisac JL, Pico MLC, Fernández Seara MJ, Gutiérrez AM, Vizcaíno C, Salvador Iglesias M, Zaplana HS, Fernández Colomer B, García López JE, Mozo RG, Martínez MTG, Muro Sebastián MD, Carbonell MB, Barnusell JB, Puiggròs MD, Taulí CP, Aloy JF, Mussons FB, Sanz IA, Galiana GG, De La Santa H, Coroleu W, Iriondo M, Castells Vilella L, Porta R, Demestre X, Martínez Nadal S, de Frutos Martínez C, López Cuesta MJ, Mora DE, Tardío JO, Benavente I, Alonso A, Aguilera Olmos R, García Cabezas MA, Martínez Jiménez MD, Jaraba Caballero MP, Ordoñez Díaz MD, Fagundo AT, Canals LM, Rodrigo FG, Martí LU, Galdo MFM, Suazo JAH, López EN, Fernández JU, Cortajarena Altuna MA, Muga Zuriarrain O, Mora Navarro D, Domínguez MT, Del Prado MYR, Díez IE, Palau Benavides MT, Lapeña S, Prada T, Mir ES, Sánchez AC, Vega EC, Del Prado N, Fernández C, Vilaplana LC, Pérez IC, Gómez LL, Comeche LD, Martín IL, González Armengod C, Labián CM, Santos Muñoz MJ, Bravo DB, Pérez V, Fernández MDE, González CD, Segura SA, Azorín ML, Md ABJ, Sánchez-Tamayo T, Moreno ET, González M, Sánchez Martínez JE, Lloreda García JM, Orayen CG, González JV, Albo MS, Colmenero EG, Gutiérrez González EP, Vacas Del Arco B, Fernández JM, Gordillo LA, Asensio MG, Díaz CM, Albújar M, Fuster Jorge P, Romero S, Falero MR, Escobar Izquierdo AB, Estañ Capell J, Izquierdo Macián MI, Montejo Vicente MM, Caballero RI, Martínez MM, Euba A, Serna AR, de Heredia Goya JML, Legorburu AP, Amorós AG, Isabel VMM, González NH, Gracia SR, Faci MPV, Villagrasa MPS, Kofron J, Strand Brodd K, Odlind A, Alberg L, Arwehed S, Hafström O, Kasemo A, Nederman K, Åhman L, Ingemarsson F, Petersson H, Thurn P, Albinsson E, Selander B, Abrahamsson T, Heimdahl I, Sveinsdottir K, Wejryd E, Hedlund A, Söderberg MK, Navér L, Brune T, Bäckström J, Robinson J, Farooqi A, Normann E, Fredriksson M, Palm A, Rosenqvist U, Walde B, Hagman C, Ohlin A, Florell R, Smedsaas-Löfvenberg A, Adams M, Meyer P, Kusche R, Schulzke S, Nelle M, Wagner B, Riedel T, Kaczala G, Pfister RE, Tolsa JF, Roth M, Stocker M, Laubscher B, Malzacher A, Micallef JP, Hegi L, Bassler D, Arlettaz R, Bernet V, Dani C, Fiorini P, Ghirri P, Tomasini B.

Author information

1
Department of Neonatal Medicine Karolinska University Hospital and Karolinska Institutet Stockholm Sweden.
2
Department of Clinical Sciences/Pediatrics Umeå University and Umeå University Hospital Umeå Sweden.
3
Neonatal Research Network of Japan Kyorin University Tokyo Japan.
4
Division of Neonatology Health Research Institute Hospital La Fe Valencia Spain.
5
Department of Pediatrics and Adolescent Medicine Turku University Hospital and University of Turku Turku Finland.
6
Gertner Institute for Epidemiology and Health Policy Research Sheba Medical Centre Tel Hashomer Israel.
7
Department of Paediatrics University of Otago Christchurch New Zealand.
8
Illinois Neonatal Network Saint Louis IL.
9
Department of Neonatology University Hospital Zurich and University of Zurich Zurich Switzerland.
10
Division of Neonatology National Center for Child Health and Development Tokyo Japan.
11
Unit of Epidemiology Meyer Children's University Hospital and Regional Health Agency Florence Italy.
12
Department of Pediatrics Mount Sinai Hospital and University of Toronto Toronto Canada.
13
Maternal-infant Care Research Centre Mount Sinai Hospital Toronto Canada.
14
Royal Hospital for Women National Perinatal Epidemiology and Statistics Unit University of New South Wales Randwick Australia.

Abstract

Background Very preterm infants are at high risk of death or severe morbidity. The objective was to determine the significance of severe congenital heart defects (CHDs) for these risks. Methods and Results This cohort study included infants from 10 countries born from 2007-2015 at 24 to 31 weeks' gestation with birth weights <1500 g. Severe CHDs were defined by International Classification of Diseases, Ninth Revision (ICD-9) and Tenth (ICD-10) codes and categorized as those compromising systemic output, causing sustained cyanosis, or resulting in congestive heart failure. The primary outcome was in-hospital mortality. Secondary outcomes were neonatal brain injury, necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity. Adjusted and propensity score-matched odds ratios (ORs) were calculated. Analyses were stratified by type of CHD, gestational age, and network. A total of 609 (0.77%) infants had severe CHD and 76 371 without any malformation served as controls. The mean gestational age and birth weight were 27.8 weeks and 1018 g, respectively. The mortality rate was 18.6% in infants with CHD and 8.9% in controls (propensity score-matched OR, 2.30; 95% CI, 1.61-3.27). Severe CHD was not associated with neonatal brain injury, necrotizing enterocolitis, or retinopathy of prematurity, whereas the OR for bronchopulmonary dysplasia increased. Mortality was higher in all types, with the highest propensity score-matched OR (4.96; 95% CI, 2.11-11.7) for CHD causing congestive heart failure. While mortality did not differ between groups at <27 weeks' gestational age, adjusted OR for mortality in infants with CHD increased to 10.9 (95% CI, 5.76-20.70) at 31 weeks' gestational age. Rates of CHD and mortality differed significantly between networks. Conclusions Severe CHD is associated with significantly increased mortality in very preterm infants.

KEYWORDS:

cardiac malformation; mortality; newborn infant; preterm birth

PMID:
32079479
DOI:
10.1161/JAHA.119.015369
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