Birth Before 39 Weeks' Gestation Is Associated With Worse Outcomes in Neonates With Heart Disease

Costello, John M.; Polito, Angelo; Brown, David W.; McElrath, Thomas F.; Graham, Dionne A.; Thiagarajan, Ravi R.; Bacha, Emile A.; Allan, Catherine K.; Cohen, Jack; Laussen, Peter C.

doi:10.1542/peds.2009-3640

Cited by 172 publications

(128 citation statements)

References 18 publications

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“…In contrast, SGA, AGA, LGA, and Z score for BW all report measures standardized for GA and sex, and as such are often used as surrogate markers for fetal growth. Increased mortality in LBW infants with CHD does not address the question of whether fetal growth—as measured by SGA/AGA/LGA or Z score for BW—impacts this outcome since the increased mortality rate in LBW infants is mainly driven by lower GA, and it is well known that GA is a major determinant of mortality in infants with7, 8, 25 and without CHD 26…”

Section: Discussionmentioning

confidence: 99%

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

Steurer

Baer

Burke

et al. 2018

JAHA

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BackgroundInfants with critical congenital heart disease (CCHD) are more likely to be small for gestational age (GA). It is unclear how this affects mortality. The authors investigated the effect of birth weight Z score on 1‐year mortality separately in preterm (GA <37 weeks), early‐term (GA 37–38 weeks), and full‐term (GA 39–42 weeks) infants with CCHD.Methods and ResultsLive‐born infants with CCHD and GA 22 to 42 weeks born in California 2007–2012 were included in the analysis. The primary predictor was Z score for birth weight and the primary outcome was 1‐year mortality. Multivariable logistic regression was used. Results are presented as adjusted odds ratios and 95% confidence intervals (CIs). The authors identified 6903 infants with CCHD. For preterm and full‐term infants, only a Z score for birth weight <−2 was associated with increased mortality compared with the reference group (Z score 0–0.5, adjusted odds ratio, 2.15 [95% CI, 1.1–4.21] and adjusted odds ratio, 3.93 [95% CI, 2.32–6.68], respectively). In contrast, in early‐term infants, the adjusted odds ratios for Z scores <−2, −2 to −1, and −1 to −0.5 were 3.42 (95% CI, 1.93–6.04), 1.78 (95% CI, 1.12–2.83), and 2.03 (95% CI, 1.27–3.23), respectively, versus the reference group.Conclusions GA seems to modify the effect of birth weight Z score on mortality in infants with CCHD. In preterm and full‐term infants, only the most severe small‐for‐GA infants (Z score <−2) were at increased risk for mortality, while, in early‐term infants, the risk extended to mild to moderate small‐for‐GA infants (Z score <−0.5). This information helps to identify high‐risk infants and is useful for surgical planning.

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Section: Discussionmentioning

confidence: 99%

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

Steurer

Baer

Burke

et al. 2018

JAHA

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“…In one study, 22 delivery of neonates with critical CHD before 39 or after 40 completed weeks was associated with increased mortality rates. Patients that delivered at 37 or 38 completed weeks were at increased risk for receiving more days of mechanical ventilation, which may be related to incomplete maturation of the lungs.…”

Section: The Deliverymentioning

confidence: 98%

“…Patients that delivered at 37 or 38 completed weeks were at increased risk for receiving more days of mechanical ventilation, which may be related to incomplete maturation of the lungs. 22 Neonates with critical CHD have a brain that is structurally similar to 34 or 35 week premature babies, and that structure may predispose them to brain injury during postnatal cardiac intervention. 22 Therefore the ideal age for delivery for these patients is at 39 to 40 weeks' gestation.…”

Section: The Deliverymentioning

confidence: 99%

“…22 Neonates with critical CHD have a brain that is structurally similar to 34 or 35 week premature babies, and that structure may predispose them to brain injury during postnatal cardiac intervention. 22 Therefore the ideal age for delivery for these patients is at 39 to 40 weeks' gestation. 22 For fetuses with HLHS and restrictive or intact atrial septum and abnormal pulmonary vein fl ow, specialized delivery room care and planning for possible urgent catheter or surgically based intervention to decompress the left atrium is recommended.…”

Section: The Deliverymentioning

confidence: 99%

“…22 Therefore the ideal age for delivery for these patients is at 39 to 40 weeks' gestation. 22 For fetuses with HLHS and restrictive or intact atrial septum and abnormal pulmonary vein fl ow, specialized delivery room care and planning for possible urgent catheter or surgically based intervention to decompress the left atrium is recommended. 15 All neonates with ductaldependent CHD require initiation of prostaglandin therapy soon after birth to maintain duct patency; therefore, delivery at a center with a neonatologist and access to cardiology is recommended.…”

Section: The Deliverymentioning

confidence: 99%

See 2 more Smart Citations

Prenatal Counseling and Care for Single-Ventricle Heart Disease: One Center’s Model for Care

Lafranchi

Lincoln

2015

Critical Care Nurse

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Advances in prenatal imaging allow early detection of single-ventricle congenital heart disease, which may enhance prenatal care and maximize care options and decision making. Boston Children's Hospital's Advanced Fetal Care Center and fetal cardiology program provide prenatal counseling and care for single-ventricle congenital heart disease. Key points for optimal prenatal counseling and education include explanation of the diagnosis, delivery, the first surgery, cardiac neurodevelopmental issues, feeding and growth issues, quality of life and long-term care, family stressors, and fetal cardiac intervention. Such counseling and education help families make the difficult decisions required in this situation. (Critical Care Nurse. 2015;35[5]:53-61)

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Perioperative Care

Backer¹,

Costello²,

Kane³

et al. 2012

Pediatric Cardiac Surgery

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Birth Before 39 Weeks' Gestation Is Associated With Worse Outcomes in Neonates With Heart Disease

Cited by 172 publications

References 18 publications

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

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

Prenatal Counseling and Care for Single-Ventricle Heart Disease: One Center’s Model for Care

Perioperative Care

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