Outcome of Extremely Preterm Infants (<1,000g) With Congenital Heart Defects From the National Institute of Child Health and Human Development Neonatal Research Network

2012 ◽  
Vol 2012 ◽  
pp. 310-311
Author(s):  
L.A. Papile
Keyword(s):  
Child Health ◽  
Human Development ◽  
Preterm Infants ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Research Network ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Abstract 12713: Epidemiology and Mortality of Very and Extremely Preterm Infants With Congenital Heart Defects

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Patricia Y Chu ◽  
Jennifer S Li ◽  
Andrzej S Kosinski ◽  
Christoph P Hornik ◽  
Kevin D Hill
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Congenital Heart ◽  
Heart Defects ◽  
Multivariate Logistic Regression Analysis ◽  
Administrative Database ◽  
Term Infants ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Nationally Representative

Introduction: Congenital heart disease (CHD) is estimated to occur in 6-10 per 1000 births. Although epidemiology and outcomes for term and near term infants with CHD are well described, data are limited for very and extremely preterm (VEP) infants. We used the Healthcare Cost and Utilization Project Kids’ Inpatient Database (KID), a nationally representative administrative database, to evaluate epidemiology and outcomes for VEP infants (25 to 32 weeks gestational age, GA) with CHD. Methods: Two separate cohorts were defined from the KID: an epidemiologic cohort including birth hospitalizations in ‘03, ’06, ’09 and ‘12; and an outcomes cohort including hospitalizations at a children’s hospital or pediatric unit for infants < 1 month of age in ‘06 and ‘09. CHD was defined by ICD-9-CM codes with severe CHD defined as those defects expected to be universally diagnosed during a preterm birth hospitalization. Weighted multivariate logistic regression analysis was used to calculate odds ratios (OR) for mortality, adjusted for race, sex, GA, year, small for gestational age and hospital teaching status. Results: Our epidemiologic and outcomes cohorts included 249,011 and 49,893 VEP infants, respectively. Incidence of CHD (116/1000 VEP births) and severe CHD (7/1000 VEP births) were both higher than previously reported in term infants. Relative risk of severe CHD in VEP vs term infants was 4.80 (95% CI 4.76, 4.84) and decreased with increasing GA (5.7 at 25 weeks GA to 4.3 at 31 weeks, p=0.005). Hospital mortality (Figure) was substantially higher for VEP infants with vs without severe CHD (26% vs 5%; adjusted OR 7.5 [95% CI: 5.9, 9.6]). Overall 16% of VEP infants with severe CHD underwent cardiac surgery during the neonatal hospitalization with mortality after surgery of 16%. Conclusions: CHD incidence is increased in very and extremely preterm infants and outcomes are poor. These data underscore the need for interventions to decrease preterm delivery when severe CHD is diagnosed in utero.

scholarly journals 37 Growth and neurodevelopment in early childhood of preterm infants with complex congenital heart defects following open cardiac surgery

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e14-e15
Author(s):  
Po-Yin Cheung ◽  
Morteza Hajihosseini ◽  
Irina Dinu ◽  
Heather Switzer ◽  
Charlene M T Robertson
Keyword(s):  
Early Childhood ◽  
Hearing Loss ◽  
Cardiac Surgery ◽  
Cerebral Palsy ◽  
Preterm Infants ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Neurodevelopmental Outcome ◽  
Neurodevelopmental Outcomes

Abstract Background Compared with those born at term gestation, infants with complex congenital heart defects (CCHD) who were delivered before 37 weeks of gestational age and received neonatal open cardiac surgery (OHS) have poorer neurodevelopmental outcomes in early childhood. Specific details related to the neurodevelopmental outcome of these infants remain unpublished. Objectives To describe the growth, disability, functional, and neurodevelopmental outcome in early childhood of preterm infants (born at &lt;37+0 weeks gestation) with CCHD and neonatal OHS. Design/Methods We studied all infants with CCHD who received OHS within 6 weeks of corrected age between 1996 and 2016. In the Western Canadian Complex Pediatric Therapies Follow-up Program, comprehensive neurodevelopmental assessments at a corrected age of 18-24 months were done by multidisciplinary teams at the original referral sites. In addition to demographic and clinical data, standardized age-appropriate outcome measures included physical growth with calculated Z-scores, disabilities including cerebral palsy, visual impairment, sensorineural hearing loss; adaptive function (Adaptive Behavioural Assessment System-II); and cognitive, language, and motor skills (Bayley Scales of Infant and Toddler Development-III). Results From 1996 to 2016, 115 preterm infants (34±2 weeks gestation, 2339±637g, 64% males) with CCHD had OHS with 11(10%) deaths before first discharge and 21 (18%) by 2 years. Prior to the first surgery, 7 (6%) neonates had cerebral injuries. Overall, 7 had necrotizing enterocolitis; none had retinopathy of prematurity. All 94 surviving infants received comprehensive evaluation at 2 years corrected age; Eighteen (19%) had congenital syndromes who had worse functional and neurodevelopmental outcomes compared to those (n=76) without syndromal abnormalities (SA) (Table). Conclusion For preterm neonates with CCHD and early OHS, the mortality was significant, but the short-term neonatal morbidity was not increased. Compared with published preterm outcomes, the early outcome suggests more cerebral palsy but not sensorineural hearing loss, and greater neurodevelopmental delay. This information is important for management care of the infants, parental counselling and the decision-making process.

scholarly journals Neonatal Outcomes in Very Preterm Infants With Severe Congenital Heart Defects: An International Cohort Study

2020 ◽  
Vol 9 (5) ◽  
Author(s):  
Mikael Norman ◽  
Stellan Håkansson ◽  
Satoshi Kusuda ◽  
Maximo Vento ◽  
Liisa Lehtonen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Infants ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Neonatal Outcomes ◽  
Very Preterm Infants ◽  
Very Preterm

Persistent pulmonary hypertension of the newborn in extremely preterm infants: a Japanese cohort study

2018 ◽  
Vol 103 (6) ◽  
pp. F554-F561 ◽  
Author(s):  
Hidehiko Nakanishi ◽  
Hideyo Suenaga ◽  
Atsushi Uchiyama ◽  
Satoshi Kusuda
Keyword(s):  
Pulmonary Hypertension ◽  
Cohort Study ◽  
Preterm Infants ◽  
Research Network ◽  
Persistent Pulmonary Hypertension ◽  
Neurodevelopmental Outcomes ◽  
Significant Independent Risk Factor ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
The Impact

ObjectiveTo investigate the characteristics of persistent pulmonary hypertension of the newborn (PPHN) in extremely preterm infants and its impact on neurodevelopmental outcomes at 3 years of age.DesignA retrospective multicentre cohort study.Settings202 tertiary perinatal centres registered in the Neonatal Research Network of Japan (NRNJ).PatientsInfants born at <28 weeks of gestational age (GA), between 2003 and 2012, were extracted from tertiary perinatal centres participating in NRNJ.Main outcome measuresDemographic characteristics, morbidity, interventions and mortality were compared for infants with and without PPHN. Multivariable logistic analysis was performed to evaluate the impact of PPHN on long-term neurodevelopmental outcomes (the prevalence rate of cerebral palsy, need for home oxygen therapy, and visual, hearing and cognitive impairment) at 3 years of age.ResultsThe prevalence of PPHN among the 12 954 extremely preterm infants enrolled was 8.1% (95% CI 7.7% to 8.6%), with the trend increasing annually, and a higher proportion as GA decreased: 18.5% (range, 15.2% to 22.4%) for infants born at 22 weeks compared with 4.4% (range, 3.8% to 5.2%) for those born at 27 weeks. Clinical chorioamnionitis and premature rupture of membranes were associated with PPHN. On multivariate analysis of the data from 5923 infants followed up for 3 years, PPHN was a significant independent risk factor for visual impairment (adjusted OR, 1.42, 95% CI 1.03 to 1.97).ConclusionsThe prevalence of PPHN in extremely preterm infants has been increasing over the past decade in Japan. Clinicians should be aware of visual impairments as a neurodevelopmental abnormality among infants with PPHN.

scholarly journals Neonatal Outcomes of Extremely Preterm Infants From the NICHD Neonatal Research Network

PEDIATRICS ◽  
2010 ◽  
Vol 126 (3) ◽  
pp. 443-456 ◽  
Author(s):  
B. J. Stoll ◽  
N. I. Hansen ◽  
E. F. Bell ◽  
S. Shankaran ◽  
A. R. Laptook ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Neonatal Outcomes ◽  
Research Network ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

scholarly journals Placental transfusion and short-term outcomes among extremely preterm infants

2020 ◽  
Vol 106 (1) ◽  
pp. 62-68
Author(s):  
Neha Kumbhat ◽  
Barry Eggleston ◽  
Alexis S Davis ◽  
Krisa P Van Meurs ◽  
Sara Bonamo DeMauro ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Random Effect ◽  
Research Network ◽  
Composite Outcome ◽  
Short Term ◽  
Delayed Cord Clamping ◽  
Major Morbidity ◽  
Cord Clamping ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

ObjectiveTo compare short-term outcomes after placental transfusion (delayed cord clamping (DCC) or umbilical cord milking (UCM)) versus immediate cord clamping among extremely preterm infants.DesignRetrospective study.SettingThe Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network registry.PatientsInfants born <29 weeks’ gestation in 2016 or 2017 without congenital anomalies who received active treatment after delivery.Intervention/exposureDCC or UCM.Main outcome measuresPrimary outcomes: (1) composite of mortality or major morbidity by 36 weeks’ postmenstrual age (PMA); (2) mortality by 36 weeks PMA and (3) composite of major morbidities by 36 weeks’ PMA. Secondary composite outcomes: (1) any grade intraventricular haemorrhage or mortality by 36 weeks’ PMA and (2) hypotension treatment in the first 24 postnatal hours or mortality in the first 12 postnatal hours. Outcomes were assessed using multivariable regression, adjusting for mortality risk factors identified a priori, significant confounders and centre as a random effect.ResultsAmong 3116 infants, 40% were exposed to placental transfusion, which was not associated with the primary composite outcome of mortality or major morbidity by 36 weeks’ PMA (adjusted OR (aOR) 1.26, 95% CI 0.95 to 1.66). However, exposure was associated with decreased mortality by 36 weeks’ PMA (aOR 0.71, 95% CI 0.55 to 0.92) and decreased hypotension treatment in first 24 postnatal hours (aOR 0.66, 95% CI 0.53 to 0.82).ConclusionIn this extremely preterm infant cohort, exposure to placental transfusion was not associated with the composite outcome of mortality or major morbidity, though there was a reduction in mortality by 36 weeks’ PMA.Trial registration numberNCT00063063.

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

2021 ◽  
Vol 8 ◽  
Author(s):  
Po-Yin Cheung ◽  
Morteza Hajihosseini ◽  
Irina A. Dinu ◽  
Heather Switzer ◽  
Ari R. Joffe ◽  
...  
Keyword(s):  
Early Childhood ◽  
Hearing Loss ◽  
Cerebral Palsy ◽  
Birth Weight ◽  
Preterm Infants ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Neurodevelopmental Outcomes

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.

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