Folate supplementation for prevention of congenital heart defects and low birth weight: an update

Objective Prematurity and low birth weight (LBW) are risk factors for increased morbidity and mortality in infants with congenital heart defects (CHDs). We sought to describe survival, inhospital morbidities, and 2-year neurodevelopmental follow-up in LBW infants with CHD. Study Design We included infants with birth weight (BW) <2,500 g diagnosed with CHD (except isolated patent ductus arteriosus) admitted January 2013 to March 2016 to a single level-IV academic neonatal intensive care unit. We reported CHD prevalence by BW and gestational age; selected in-hospital morbidities and mortality by infant BW, CHD type, and surgical intervention; and developmental outcomes by Bayley's scales of infant and toddler development, third edition (BSID-III) scores at age 2 years. Results Among 420 infants with CHD, 28 (7%) underwent cardiac surgery. Median (25th and 75th percentiles) gestational age was 30 (range: 27–33) weeks and BW was 1,258 (range: 870–1,853) g. There were 134 of 420 (32%) extremely LBW (<1,000 g) infants, 82 of 420 (20%) were small for gestational age, and 51 of 420 (12%) multiples. Most common diagnosis: atrial septal defect (260/420, 62%), followed by congenital anomaly of the pulmonary valve (75/420, 18%). Most common surgical procedure: pulmonary artery banding (5/28, 18%), followed by the tetralogy of Fallot corrective repair (4/28, 14%). Survival to discharge was 88% overall and lower among extremely LBW (<1,000 g, 81%) infants and infants undergoing surgery (79%). Comorbidities were common (35%); retinopathy of prematurity and bronchopulmonary dysplasia were most prevalent. BSID-III scores were available on 148 of 176 (84%); any scores <85 were noted in 73 of 148 (49%), with language being most commonly affected. Conclusion Among LBW infants with congenital heart disease, hospital mortality varied by BW and cardiac diagnosis. Key Points

Download Full-text

Residential Exposure To Traffic Pollution And Congenital Heart Defects, Preterm Births, And Low Birth Weight In Lanzhou, China

ISEE Conference Abstracts ◽

10.1289/isee.2015.2015-518 ◽

2015 ◽

Vol 2015 (1) ◽

pp. 518

Author(s):

Lan Jin ◽

Qing Liu ◽

Jie Qiu ◽

Yaqun Zhang ◽

Weitao Qiu ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects ◽

Preterm Births ◽

Traffic Pollution ◽

Residential Exposure

Download Full-text

Academic Achievement Among Children with Congenital Heart Defects in Arkansas

International Journal for Population Data Science ◽

10.23889/ijpds.v5i5.1635 ◽

2020 ◽

Vol 5 (5) ◽

Author(s):

Suman Maity ◽

Nahed El-hassan ◽

Anthony Goudie ◽

Jeffrey R Kaiser ◽

Wendy N Nembhard

Keyword(s):

Birth Weight ◽

Congenital Heart Defects ◽

Gestational Age ◽

Congenital Heart ◽

Maternal Education ◽

Heart Defects ◽

Birth Certificate ◽

Educational Performance ◽

Negatively Associated ◽

Race Ethnicity

Children with congenital heart defects (CHD) have impaired cognitive development. The objective was to determine if children with CHDs differed in academic performance during elementary and middle school years from children without CHDs. Data from the state birth defects registry, Arkansas Reproductive Health Monitoring System (ARHMS), birth certificate records, and achievement test-scores (grades 3-8) from the Arkansas Department of Education were linked using unique identifiers for children born between 2000-2011 in Arkansas. Cases were identified using 6-digit British Paediatric Association codes and matched controls were assigned from birth certificate data. Proficiency (yes/no) on achievement tests was determined using standard thresholds per grade. Data were stratified based on sex, gestational age, and birth weight. Odds ratios (OR) and 95% confidence intervals (CI) were calculated from multivariate logistic regression adjusting for maternal education level and age, race/ethnicity, and infant sex. A total of 3,730 children with CHDs and 7,385 children without CHDs were evaluated. Children with CHD were less likely to be proficient in early elementary school grades for mathematics (3rd: OR=0.72, 95% CI: 0.59, 0.87; 4th: OR=0.77, 95% CI: 0.62, 0.95) and literacy (3rd: OR=0.75, 95% CI: 0.63, 0.89; 4th: OR=0.72, 95% CI: 0.58, 0.90). The trend of being less proficient associated with CHD remained mostly consistent with sex, gestational age, and birth weight. In multivariate analysis, CHD was negatively associated with being proficient in mathematics and literacy. Maternal education (1-3 years beyond high school) was positively associated with test proficiency. Additionally, non-Hispanic (NH) black children had lower odds of being proficient compared to NH white children. Educational performance was negatively associated with CHD in early elementary grades; there was no difference in later grades. However, larger sample sizes in later grades are necessary for reliable estimates. Maternal education and race/ethnicity were significant factors associated with childhood educational performance.

Download Full-text

The incidence and diagnostics of congenital heart defects in Kaunas infant population during 1999–2005

Medicina ◽

10.3390/medicina44020018 ◽

2008 ◽

Vol 44 (2) ◽

pp. 139

Author(s):

Virginija Dulskienë ◽

Vilija Malinauskienë ◽

Ada Azaravièienë ◽

Renata Kuèienë

Keyword(s):

Birth Weight ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects ◽

Epidemiological Methods ◽

Normal Birth ◽

Congenital Heart Malformations ◽

Increased Risk ◽

Heart Malformation ◽

Heart Malformations

The objective of this study was to determinate the incidence and diagnostics of congenital heart defects in Kaunas infant population in 1999–2005 and to compare the data obtained with the data of years 1995–1998. Subject and methods. The study population comprised all newborns born in Kaunas city during 1999– 2005. Congenital heart defects were registered based on clinical diagnosis after its verification using the data from consulting centers and pediatric outpatient departments. To assess the incidence of congenital heart malformations in newborn population, we conducted a validated newborn register based on maternal residential district. Modern epidemiological methods were used for data analysis. Results. In 1999–2005, there were 24 069 live births in Kaunas: 2231 newborns were born with congenital anomalies, 198 had congenital heart malformations. The incidence of congenital heart defects was 8.2 per 1000 live newborns. The majority of congenital heart malformations were diagnosed in delivery units (93.94%). We have analyzed the relationship between birth weight and gestational age of newborns with congenital heart malformations. Newborns with low birth weight were at significantly higher risk of congenital heart malformation than newborns with normal birth weight (OR=3.52, 95% CI, 2.25–5.47). Our data also showed that newborns born before 32 weeks of gestation had a 5-fold increased risk of congenital heart malformation (OR=5.20; 95% CI, 2.50–10.84) and infants born before 37 weeks of gestation had a 4-fold increased risk (OR=4.08; 95% CI, 2.68–6.19) compared with newborns born after 37 weeks of gestation. Conclusions. This study shows that incidence of congenital heart anomalies in Kaunas newborn population was 8.2 cases per 1000 live newborns in 1999–2005. It was determined that during 1999–2005, the number of above-mentioned anomalies diagnosed in delivery units increased by 23%.

Download Full-text

Maternal MTHFR 677C>T is a risk factor for congenital heart defects: effect modification by periconceptional folate supplementation

European Heart Journal ◽

10.1093/eurheartj/ehi815 ◽

2006 ◽

Vol 27 (8) ◽

pp. 981-987 ◽

Cited By ~ 79

Author(s):

Ingrid M. van Beynum ◽

Livia Kapusta ◽

Martin den Heijer ◽

Sita H.H.M. Vermeulen ◽

Margreet Kouwenberg ◽

...

Keyword(s):

Risk Factor ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects ◽

Effect Modification ◽

Folate Supplementation

Download Full-text

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

Frontiers in Pediatrics ◽

10.3389/fped.2020.616659 ◽

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.

Download Full-text