Impact of Congenital Heart Disease on the Outcomes of Very Low Birth Weight Infants

Xuxin Chen; Shazia Bhombal; David M. Kwiatkowski; Michael Ma; Valerie Y. Chock

doi:10.1055/s-0044-1781460

American Journal of Perinatology, Table of Contents

Am J Perinatol 2024; 41(13): 1815-1821
DOI: 10.1055/s-0044-1781460

Original Article

Impact of Congenital Heart Disease on the Outcomes of Very Low Birth Weight Infants

Xuxin Chen

¹Division of Neonatology, Department of Pediatrics, New York-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York

,

Shazia Bhombal

²Division of Neonatology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia

,

David M. Kwiatkowski

³Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California

,

Michael Ma

⁴Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California

,

Valerie Y. Chock

⁵Division of Neonatology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California

› Author Affiliations

Abstract

Objective This study aimed to investigate the association of congenital heart disease (CHD) with morbidity and mortality of very low birth weight (VLBW) infants.

Study Design This matched case–control study included VLBW infants born at a single institution between 2001 and 2015. The primary outcome was mortality. Secondary outcomes included necrotizing enterocolitis, bronchopulmonary dysplasia (BPD), sepsis, retinopathy of prematurity, and intraventricular hemorrhage. These outcomes were assessed by comparing VLBW-CHDs with control VLBW infants matched by gestational age within a week, birth weight within 500 g, sex, and birth date within a year using conditional logistic regression. Multivariable logistic regression analyzed differences in outcomes in the VLBW-CHD group between two birth periods (2001–2008 and 2009–2015) to account for changes in practice.

Results In a cohort of 44 CHD infants matched with 88 controls, the mortality rate was 27% in infants with CHD and 1% in controls (p < 0.0001). The VLBW-CHDs had increased BPD; (odds ratio [OR]: 7.70, 95% confidence interval [CI]: 1.96–30.29) and sepsis (OR: 10.59, 95% CI: 2.99–37.57) compared with the control VLBWs. When adjusted for preoperative ventilator use, the VLBW-CHDs still had significantly higher odds of BPD (OR: 6.97, 95% CI: 1.73–28.04). VLBW-CHDs also had significantly higher odds of both presumed and culture-positive sepsis as well as late-onset sepsis than their matched controls. There were no significant differences in outcomes between the two birth periods.

Conclusion VLBW-CHDs showed higher odds of BPD, sepsis, and mortality than VLBW infants without CHD. Future research should focus on the increased mortality and specific complications encountered by VLBW infants with CHD and implement targeted strategies to address these risks.

Key Points

Incidence of CHD is higher in preterm infants than in term infants but the incidence of their morbidities is not well described.
VLBW infants with CHD have higher odds of mortality, bronchopulmonary dysplasia, and sepsis.
Future research is needed to implement targeted preventive responses.

Keywords

congenital heart disease - preterm - very low birth weight - neonates

Full Text

References

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