Contemporary pregnancy outcomes for women with moderate and severe congenital heart disease

Background Women with congenital heart disease (CHD) are surviving into adulthood, with more undergoing pregnancy. Methods Retrospective review of the Vizient database from 2017–2019 for women 15–44 years old with moderate, severe or no CHD and vaginal delivery or caesarean section. Demographics, hospital outcomes and costs were compared. Results There were 2,469,117 admissions: 2,467,589 with no CHD, 1277 with moderate and 251 with severe CHD. Both CHD groups were younger than no CHD, there were fewer white race/ethnicity in the no CHD group and more women with Medicare in both CHD groups compared to no CHD. With increasing CHD severity there was an increase in length of stay, ICU admission rates and costs. There were also higher rates of complications, mortality and caesarean section in the CHD groups. Conclusion Pregnant women with CHD have more problematic pregnancies and understanding this impact is important to improve management and decrease healthcare utilization.

Prevalence and Infant Mortality of Major Congenital Malformations Stratified by Birthweight

<b><i>Background:</i></b> Low birthweight and major congenital malformations (MCMs) are key causes of infant mortality. <b><i>Objectives:</i></b> The aim of this study was to explore the prevalence of MCMs in infants with low and very low birthweight and analyze the impact of MCMs and birthweight on infant mortality. <b><i>Methods:</i></b> We determined prevalence and infant mortality of 28 life-threatening MCMs in very-low-birthweight (&#x3c;1,500 g, VLBW), low-birthweight (1,500–2,499 g, LBW), or normal-birthweight (≥2,500 g, NBW) infants in a cohort of 2,727,002 infants born in Germany in 2006–2017, using de-identified administrative data of the largest statutory public health insurance system in Germany. <b><i>Results:</i></b> The rates of VLBW, LBW, and NBW infants studied were 1.3% (34,401), 4.0% (109,558), and 94.7% (2,583,043). MCMs affected 0.5% (13,563) infants, of whom &#x3e;75% (10,316) had severe congenital heart disease. The prevalence (per 10,000) of any/cardiac MCM was increased in VLBW (286/176) and LBW (244/143), as compared to NBW infants (38/32). Infant mortality rates were significantly higher in infants with an MCM, as opposed to infants without an MCM, in each birthweight group (VLBW 28.5% vs. 11.5%, LBW 16.7% vs. 0.9%, and NBW 8.6% vs. 0.1%). For most MCMs, observed survival rates in VLBW and LBW infants were lower than expected, as calculated from survival rates of VLBW or LBW infants without an MCM, and NBW infants with an MCM. <b><i>Conclusions:</i></b> Infants with an MCM are more often born with LBW or VLBW, as opposed to infants without an MCM. Many MCMs carry significant excess mortality when occurring in VLBW or LBW infants.

CASE REPORT – COVID-19 Infection in Infant with Severe Congenital Heart Disease

We describe the case of a 2 month old born with hypoplastic left heart syndrome who presented with fever and vomiting and was found to be infected with the novel corona virus (COVID-19). He underwent treatment with supplemental oxygen, heparin, and dexamethasone. After a 6 day hospitalization he recovered remarkably well without major adverse effects.