Gestational Age and Outcomes in Critical Congenital Heart Disease

Steurer, Martina A.; Baer, Rebecca J.; Keller, Roberta L.; Oltman, Scott P.; Chambers, Christina D.; Norton, Mary E.; Peyvandi, Shabnam; Rand, Larry; Rajagopal, Satish; Ryckman, Kelli K.; Moon-Grady, Anita J.; Jelliffe‐Pawlowski, Laura L.

doi:10.1542/peds.2017-0999

Cited by 84 publications

(57 citation statements)

References 37 publications

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“…Different results were reported by Steure and coauthors. [20] Late preterm infants in our study were found to have more neonatal complications compared to full-term infants. Nearly 32.9% of LPT infants had clinical symptoms of respiratory distress, and the most common cause of it in LPs was RDS.…”

Section: Discussionmentioning

confidence: 47%

Outcome of Late Preterm Newborns

El-Hawary

Elgameel

Amin

et al. 2019

Fayoum University Medical Journal

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Background: Preterm birth rates continue to rise. Suggestions have been made that preterm birth rates have also increased because of a dramatic rise in late preterm births, defined as births between 34 weeks and 36-6/7 weeks of gestation. Latepreterm births are considered functionally mature but, several line of evidences suggest that, compared with term neonates, they have a higher risk of complications. Objectives: The present study was done to compare the outcome of late preterm infants born in our hospital, compared to those born at term. Patients and Methods: This is a prospective study conducted on 250 newborn born in maternal unit and neonatal intensive care unit of Fayoum University Hospital and BeniSuef General Hospital during 6 consecutive months(the period from May 2015 to November 2015).The study sample comprised late-preterm infants (cases) and a group of full term newborns(controls). Maternal, gestational and neonatal variables were analyzed. Means and standard deviations were used to compare numerical variables between case and control groups using Kolmogorov-Smirnov test (KS) and the Mann-Whitney test.

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Section: Discussionmentioning

confidence: 47%

Outcome of Late Preterm Newborns

El-Hawary

Elgameel

Amin

et al. 2019

Fayoum University Medical Journal

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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%

“…However, more recently, early‐term infant vulnerability has been documented and several studies in infants without CCHD have shown that early‐term infants born at 37 to 38 weeks have a higher incidence of respiratory distress, developmental morbidities, and even infant mortality 32, 33. In infants with CCHD, 2 studies have shown increased mortality, neonatal morbidities, and postoperative complications in early‐term versus full‐term infants 7, 8. Our current study suggests that Z score for BW has the most granular effect in early‐term infants with CCHD, making this group particularly vulnerable.…”

Section: Discussionmentioning

confidence: 99%

“…To adjust for complexity of CCHD, we used 6 severity groups modified from risk adjustment in congenital heart surgery (RACHS)20 as further detailed in Steurer et al 7. It was not possible to use RACHS in its original form, since some surgical details needed for classifications were not available in this database.…”

Section: Methodsmentioning

confidence: 99%

“…Two recent studies investigated the impact of gestational age (GA) at birth on postnatal outcomes in infants with CCHD 7, 8. Both studies found that the length of gestation independently affects mortality, postoperative complications, and neonatal morbidity after adjusting for severity of CHD, and that early‐term infants (GA 37–38 weeks) are at higher risk for poor outcomes compared with full‐term infants (GA ≥39 weeks).…”

Section: Introductionmentioning

confidence: 99%

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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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Pregnancy loss in major fetal congenital heart disease: incidence, risk factors and timing

Jepson

Metz

Miller

et al. 2023

Ultrasound in Obstet & Gyne

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What are the novel findings of this work?This study demonstrates a higher risk of pregnancy loss in fetuses with major congenital heart disease (CHD) compared with the general population. The increase in the risk of pregnancy loss is particularly prominent in the presence of additional fetal diagnoses and specific cardiac diagnoses, such as hypoplastic left heart syndrome and single-ventricle heart disease. What are the clinical implications of this work?Increased understanding of the incidence, associated risk factors and timing of pregnancy loss in the population with major fetal CHD should inform patient counseling and risk stratification to guide future investigation of optimal antenatal surveillance strategies.

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Gestational Age and Outcomes in Critical Congenital Heart Disease

Abstract: Infants born with CCHD are at high risk of neonatal morbidity. Morbidity remains increased across all GA groups in comparison with infants born at 39 to 42 weeks. This substantial risk of neonatal morbidity is important to consider when caring for this patient population.

Cited by 84 publications

References 37 publications

Outcome of Late Preterm Newborns

Outcome of Late Preterm Newborns

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

Pregnancy loss in major fetal congenital heart disease: incidence, risk factors and timing

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