Congenital Heart Disease in Premature Infants 25-32 Weeks' Gestational Age

Abstract

Objective To determine the birth prevalence of congenital heart defects (CHDs) across the spectrum of common defects in very/extremely premature infants and to compare mortality rates between premature infants with and without CHDs. Study design The Kids' Inpatient Databases (2003-2012) were used to estimate the birth prevalence of CHDs (excluding patent ductus arteriosus) in very/extremely premature infants born between 25 and 32 weeks gestational age (GA). Birth prevalence was compared with term infants for a subset of “severe” defects expected to be near universally diagnosed in the neonatal period. Weighted multivariable logistic regression was used to calculate adjusted odds ratios of mortality comparing very and extremely premature infants with versus without CHDs. Results We identified 249,011 very/extremely premature infants, including 28,806 with CHDs. The overall birth prevalence of CHDs was 116 per 1000 very/extremely premature births. Severe CHDs had significantly higher birth prevalence in very/extremely premature infants when compared with term infants (7.4 per 1000 very/premature births versus 1.5 per 1000 term births, p<0.001). Very/extremely premature infants with severe CHDs had an overall 26.3% in-hospital mortality and a 7.5-fold increased adjusted odds of death compared with those without CHDs. Mortality varied widely by defect in very/extremely premature infants, ranging from 12% for interrupted aortic arch to 67% for truncus arteriosus. Conclusion Given the increased birth prevalence of severe CHDs in very/extremely premature infants, and significantly higher mortality, there is justification for intensive interventions aimed at decreasing the likelihood of premature delivery for patients where CHD is diagnosed in utero.

Incidental Findings on Routine Targeted Neonatal Echocardiography Performed in Preterm Neonates Younger Than 29 Weeks’ Gestation

“…Their results were consistent with a 2012 European study, which found that children with CHD (atrial septal defect and PDA) were twice as likely to be born prematurely (<37 weeks) or very/extremely prematurely (<32 weeks) than children without CHD . Additionally, Chu et al reported that the birth prevalence of severe defects was markedly higher for neonates born more prematurely: 8.8 at 35 to 36 weeks compared to 6.7 at 31 to 32 weeks per 1000 birth hospitalizations ( P = .05), and greater prematurity was also associated with higher mortality, with very/extremely premature neonates who had severe CHD at a 7.5‐fold increased adjusted odds ratio of death compared to those without CHD. Other unexpected findings identified in our study were 5 (3%) neonates with PH and 3 (2%) with pericardial effusions.…”

“…A recent study by Chu et al found that premature neonates had a significantly higher birth prevalence of severe CHD compared to term neonates (7.4 per 1000 very/premature births versus 1.5 per 1000 term births; P < 0.01). Their results were consistent with a 2012 European study, which found that children with CHD (atrial septal defect and PDA) were twice as likely to be born prematurely (<37 weeks) or very/extremely prematurely (<32 weeks) than children without CHD .…”

Duct-dependent congenital heart disease in very preterm infants

“…The in-hospital mortality of 25% and incidence of major neonatal morbidity (NEC, intraventricular haemorrhage (stage III or greater), periventricular leukomalacia, retinopathy of prematurity or bronchopulmonary dysplasia) of 44% in our study are similar to those previously reported 3 4. Given the retrospective nature and small population of our study, causation cannot be established.…”

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

“…The current study included a high proportion of infants (62%) diagnosed with ASDs, which are commonly diagnosed in premature infants (possibly because of the increased use of echocardiograms in this population), but are not typically associated with mortality at an early age. 22,26,27 In studies where the prevalence of ASD is lower, mortality at NICU discharge was 44%. 24 Similarly, when infants with isolated ASD diagnoses are excluded from the study, as was the case in a report from the Vermont Oxford Network, or Pediatrix Medical Group Data Warehouse, mortality was again higher at 44 and 55%, respectively.…”