Outcomes of Preterm Infants With Congenital Heart Defects After Early Surgery: Defining Risk Factors at Different Time Points During Hospitalization

Abstract

Background: Compared with those born at term gestation, infants with complex congenital heart defects (CCHD) who were delivered before 37 weeks gestational age and received neonatal open-heart surgery (OHS) have poorer neurodevelopmental outcomes in early childhood. We aimed to describe the growth, disability, functional, and neurodevelopmental outcomes in early childhood of preterm infants with CCHD after neonatal OHS. Prediction models were evaluated at various timepoints during hospitalization which could be useful in the management of these infants.Study Design: We studied all preterm infants with CCHD who received OHS within 6 weeks of corrected age between 1996 and 2016. The Western Canadian Complex Pediatric Therapies Follow-up Program completed multidisciplinary comprehensive neurodevelopmental assessments at 2-year corrected age at the referral-site follow-up clinics. We collected demographic and acute-care clinical data, standardized age-appropriate outcome measures including physical growth with calculated z-scores; disabilities including cerebral palsy, visual impairment, permanent hearing loss; adaptive function (Adaptive Behavior Assessment System-II); and cognitive, language, and motor skills (Bayley Scales of Infant and Toddler Development-III). Multiple variable logistic or linear regressions determined predictors displayed as Odds Ratio (OR) or Effect Size (ES) with 95% confidence intervals.Results: Of 115 preterm infants (34 ± 2 weeks gestation, 2,339 ± 637 g, 64% males) with CCHD and OHS, there were 11(10%) deaths before first discharge and 21(18%) deaths by 2-years. Seven (6%) neonates had cerebral injuries, 7 had necrotizing enterocolitis; none had retinopathy of prematurity. Among 94 survivors, 9% had cerebral palsy and 6% had permanent hearing loss, with worse outcomes in those with syndromic diagnoses. Significant predictors of mortality included birth weight z-score [OR 0.28(0.11,0.72), P = 0.008], single-ventricle anatomy [OR 5.92(1.31,26.80), P = 0.021], post-operative ventilation days [OR 1.06(1.02,1.09), P = 0.007], and cardiopulmonary resuscitation [OR 11.58 (1.97,68.24), P = 0.007]; for adverse functional outcome in those without syndromic diagnoses, birth weight 2,000–2,499 g [ES −11.60(−18.67, −4.53), P = 0.002], post-conceptual age [ES −0.11(−0.22,0.00), P = 0.044], post-operative lowest pH [ES 6.75(1.25,12.25), P = 0.017], and sepsis [ES −9.70(−17.74, −1.66), P = 0.050].Conclusions: Our findings suggest preterm neonates with CCHD and early OHS had significant mortality and morbidity at 2-years and were at risk for cerebral palsy and adverse neurodevelopment. This information may be important for management, parental counseling and the decision-making process.

Growth and risk of adverse neuro‐developmental outcome in infants with congenital heart disease: A systematic review

“…10 333 studies were not relevant. Full text of 51 studies was sought and 20 were included in the final review, 12–31 PRISMA diagram (Figure 1).…”

“…10 333 studies were not relevant. Full text of 51 studies was sought and 20 were included in the final review, 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 PRISMA diagram (Figure 1 ).…”

“…10 333 studies were not relevant. Full text of 51 studies was sought and 20 were included in the final review, [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] PRISMA diagram (Figure 1). 1 and 2) Setting: All included studies came from high-income countries.…”

A guide to prenatal counseling regarding neurodevelopment in congenital heart disease

“…Postnatal factors • Placental abnormalities 66,67 • Maternal stress 68 • Familial history of mental and neurological disorders 69 • Male gender 12,28 • Caucasian 12 • Post-natal diagnosis 70 • Low birthweight 12,24,65,71 • Reduced head circumference at birth 71 • Prematurity 72 • Brain immaturity 73 • Brain injury (white matter injury, stroke, hemorrhage) 74 -77 • Smaller ascending aorta diameter 21 • Higher pre-operative cerebral blood flow 78 • Severe pre-operative acidosis and hypoxia 79 • Longer time to surgery 78 • APOEε2 polymorphism 64 • Circulatory insufficiency/low cardiac output 79,80 • Cardiac arrest or history of cardiopulmonary resuscitation 81 • Extracorporeal membrane oxygenation 28,81,82 • Ventricular assist device 81 • Heart transplant 83 • Mechanical ventilation 80 • Tube feeding 84,85 • Poor growth 85,86 • Seizure 13,21,27,28,67 • Systemic inflammatory reaction 87 • Longer hospital or post-operative length of stay 24,65,81,85 • Increased course complexity and complications …”

Necrotizing Enterocolitis Associated with Congenital Heart Disease—A Review Article

“… 22 The incidence of NEC in premature infants with CHD is actually higher than those with idiopathic NEC, presumably because these infants not only have the classic risk factors of preterm babies but also the hemodynamic changes observed in CHD. 4 , 20 , 23 – 25 …”