Impact of Comorbid Prematurity and Congenital Anomalies: A Review

Abstract

Preterm infants are more likely to be born with congenital anomalies than those who are born at full-term. Conversely, neonates born with congenital anomalies are also more likely to be born preterm than those without congenital anomalies. Moreover, the comorbid impact of prematurity and congenital anomalies is more than cumulative. Multiple common factors increase the risk of brain injury and neurodevelopmental impairment in both preterm babies and those born with congenital anomalies. These include prolonged hospital length of stay, feeding difficulties, nutritional deficits, pain exposure and administration of medications including sedatives and analgesics. Congenital heart disease provides a well-studied example of the impact of comorbid disease with prematurity. Impaired brain growth and maturity is well described in the third trimester in this population; the immature brain is subsequently more vulnerable to further injury. There is a colinear relationship between degree of prematurity and outcome both in terms of mortality and neurological morbidity. Both prematurity and relative brain immaturity independently increase the risk of subsequent neurodevelopmental impairment in infants with CHD. Non-cardiac surgery also poses a greater risk to preterm infants despite the expectation of normal in utero brain growth. Esophageal atresia, diaphragmatic hernia and abdominal wall defects provide examples of congenital anomalies which have been shown to have poorer neurodevelopmental outcomes in the face of prematurity, with associated increased surgical complexity, higher relative cumulative doses of medications, longer hospital and intensive care stay and increased rates of feeding difficulties, compared with infants who experience either prematurity or congenital anomalies alone.

Comorbidities in congenital heart disease: different patterns in childhood and adulthood

“…We found that the most common comorbidities were perinatal diseases (87.50%) in children with CHD, and 47.55% of children with perinatal diseases also reported CHD. A study showed that newborns with CHD were more likely to be born prematurely and/or small for gestational age than those without CHD [ 17 ], which was consistent with our findings. According to clinical experience, the symptoms of CHD patients are shortness of breath, heart murmur, low body weight, and repeated respiratory tract infections [ 18 ].…”

Thoracoscopic Stage Internal Traction Repair Reduces Time to Achieve Esophageal Continuity in Long Gap Esophageal Atresia

“…[24][25][26] Other studies have also remarked that a prolonged hospital stay may be related to suboptimal longterm morbidity and neurodevelopment outcomes. 27,28 Postoperative complications such as gastroesophageal reflux disease with need for antireflux surgery and anastomotic strictures were similar among analyzed centers. Although not statistically significant, there were observed differences in the rate of anastomotic leakage (15% for center A and 0% for center B), which may result from the utilization of routine postoperative contrast study; importantly, there were no leaks that required surgical management.…”

“…A long initial hospital stay, as well as significant associated anomalies, and persistent digestive or respiratory symptoms may negatively influence on health related quality of life (HRQOL) [24]. Other studies have also remarked that a prolonged hospital stay may be related to suboptimal long-term morbidity and neurodevelopment outcomes [25,26].…”

Sepsis-associated injury of the nervous system in premature infants with very low body weight

“…З одного боку, існує значна кількість антенатальних факторів ризику, що можуть як безпосередньо спричиняти неонатальне ураження головного мозку, так і виступати в ролі тригерів у неонатальному періоді. З іншого боку, передчасно народжені діти є найбільш уразливою категорією пацієнтів загалом і навіть за найбільш сприятливого перебігу неонатального періоду потребують додаткової респіраторної підтримки, значної кількості інвазивних медичних втручань і мають великий ризик інфекційних ускладнень [7,11]. За даними останніх досліджень, частота раннього неонатального сепсису сягає близько 11 випадків на 1000 немовлят, народжених із масою <1500 г. Рівень захворюваності на пізній неонатальний сепсис становить 51,2% у немовлят з ЕММТ, 15-25% у немовлят із ДММТ і 1,6% у немовлят із масою ≥2500 г [3,10].…”