Prevalence and Outcomes of Congenital Heart Disease in Very Low Birth Weight Preterm Infants: An Observational Study From the Brazilian Neonatal Network Database

Abstract

Objectives: To evaluate the prevalence of congenital heart disease and their outcomes in a Brazilian cohort of very low birth weight preterm infants. Design: Post hoc analysis of data from the Brazilian Neonatal Network database, complemented by retrospective data from medical charts and a cross-sectional survey. Setting: Twenty public tertiary-care university hospitals. Patients: A total of 13,955 newborns weighing from 401 to 1,499 g and between 22 and 36 weeks of gestational age, born from 2010 to 2017. Interventions: None. Measurements and Main Results: The prevalence of congenital heart disease was 2.45% (95% CI, 2.20–2.72%). In a multivariate regression analysis, risk factors associated with congenital heart disease were maternal diabetes (relative risk, 1.55; 95% CI, 1.11–2.20) and maternal age above 35 years (relative risk, 2.09; 95% CI, 1.73–2.51), whereas the protection factors were maternal hypertension (relative risk, 0.54; 95% CI, 0.43–0.69), congenital infection (relative risk, 0.45; 95% CI, 0.21–0.94), and multiple gestation (relative risk, 0.73; 95% CI, 0.55–0.97). The pooled standardized mortality ratio in patients with congenital heart disease was 2.48 (95% CI, 2.22–2.80), which was significantly higher than in patients without congenital heart disease (2.08; 95% CI, 2.03–2.13). However, in multiple log-binomial regression analyses, only the presence of major congenital anomaly, gestational age (< 29 wk; relative risk, 2.32; 95% CI, 2.13–2.52), and Score for Neonatal Acute Physiology and Perinatal Extension II (> 20; relative risk, 3.76; 95% CI, 3.41–4.14) were independently associated with death, whereas the effect of congenital heart disease was spotted only when a conditional inference tree approach was used. Conclusions: The overall prevalence of congenital heart disease in this cohort of very low birth weight infants was higher and with higher mortality than in the general population of live births. The occurrence of a major congenital anomaly, gestational age (< 29 wk), and Score for Neonatal Acute Physiology and Perinatal Extension II (> 20) were significantly and independently associated with death, whereas the association of congenital heart disease and death was only evident when a major congenital anomaly was present.

Infant congenital heart disease prevalence and mortality in French Guiana: a population-based study

“…Rare published studies originating from the LAC region indicate highly variable prevalence rates between countries such as Brazil, Ecuador and Peru, with differing methodologies between studies in terms of information sources, data exhaustiveness, case and outcome definitions, study population selection criteria, as well as the absence of reliable data pertaining to infants under 1 year or complex CHD subtypes. 13 , 14 , 29 , 30 , 31 , 32 , 33 To date, the main regional reference for the LAC region and the rest of South America remains the CHD prevalence projections at birth from the Global Burden of Disease (GBD) study with estimates for prevalence and mortality for overall CHD and different CHD sub-types in infants under 1 year available only in the GBD 1990–2017 study. 12 , 13 As with EPICARD, due to divergent eligibility criteria for CHD cases, overall live birth CHD prevalence and related infant mortality could not be directly compared between GBD and French Guiana.…”

“… 13 , 14 , 29 , 30 , 31 , 32 , 33 To date, the main regional reference for the LAC region and the rest of South America remains the CHD prevalence projections at birth from the Global Burden of Disease (GBD) study with estimates for prevalence and mortality for overall CHD and different CHD sub-types in infants under 1 year available only in the GBD 1990–2017 study. 12 , 13 As with EPICARD, due to divergent eligibility criteria for CHD cases, overall live birth CHD prevalence and related infant mortality could not be directly compared between GBD and French Guiana. Only FUH prevalence could be contrasted between both studies due to homogenous Group 6 definitions (according to the Anatomical and Clinical Classification of Congenital Heart Defects).…”

“… 4 Until now, only a few studies have carefully assessed the prevalence and mortality of newborns with either simple or complex CHD, 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 while other authors have either limited their focus to the most severe or the most frequent defects, or to premature and very low-weight infants. 1 , 7 , 13 , 14 …”

Congenital Heart Disease in a Tertiary Care NICU; Pattern, Risk Factors and Outcome

“…In which maternal diabetes and maternal age above 35 years were associated with congenital heart disease, whereas the protection factors were maternal hypertension, congenital infection, and multiple gestation. 6 A population-based case-control study (242 CHD cases, 966 controls) was conducted in northern Ireland by using an iPad questionnaire for mother with linkage to maternity and first trimester prescription records. Risk of CHD was associated with low maternal education, pregestational diabetes, self-reported maternal clotting disorders, prescriptions for the anticlotting medication enoxaparin and self-reported vaginal infections.…”