Elsevier

The Journal of Pediatrics

Volume 181, February 2017, Pages 37-41.e1
The Journal of Pediatrics

Original Articles
Congenital Heart Disease in Premature Infants 25-32 Weeks' Gestational Age

https://doi.org/10.1016/j.jpeds.2016.10.033Get rights and content

Objective

To determine the birth prevalence of congenital heart defects (CHDs) across the spectrum of common defects in very/extremely premature infants and to compare mortality rates between premature infants with and without CHDs.

Study design

The Kids' Inpatient Databases (2003-2012) were used to estimate the birth prevalence of CHDs (excluding patent ductus arteriosus) in very/extremely premature infants born between 25 and 32 weeks' gestational age. Birth prevalence was compared with term infants for a subset of “severe” defects expected to be near universally diagnosed in the neonatal period. Weighted multivariable logistic regression was used to calculate aORs of mortality comparing very and extremely premature infants with vs without CHDs.

Results

We identified 249 011 very/extremely premature infants, including 28 806 with CHDs. The overall birth prevalence of CHDs was 116 per 1000 very/extremely premature births. Severe CHDs had significantly higher birth prevalence in very/extremely premature infants when compared with term infants (7.4 per 1000 very/premature births vs 1.5 per 1000 term births; P < .001). Very/extremely premature infants with severe CHDs had an overall 26.3% in-hospital mortality and a 7.5-fold increased adjusted odds of death compared with those without CHDs. Mortality varied widely by defect in very/extremely premature infants, ranging from 12% for interrupted aortic arch to 67% for truncus arteriosus.

Conclusions

Given the increased birth prevalence of severe CHDs in very/extremely premature infants, and significantly higher mortality, there is justification for intensive interventions aimed at decreasing the likelihood of premature delivery for patients where CHD is diagnosed in utero.

Section snippets

Methods

We performed a retrospective cohort study using the 2003, 2006, 2009, and 2012 Healthcare Cost and Utilization Project Kids' Inpatient Database (KID). The KID is the largest publicly available all-payer pediatric inpatient database and includes approximately 7 million estimated hospitalizations in community, academic, and private hospitals in 44 states. It is a 20% stratified sample of discharges for patients younger than 21 years across the country collected by the Agency for Healthcare

Results

An estimated 249 011 infants were born between 25 and 32 weeks GA, of which 28 806 (116 per 1000 birth hospitalizations of very/extremely premature infants) had CHDs. Of those infants with CHDs, 48.6% were female and 5.9% were SGA (Table III).

Table IV summarizes the birth prevalence of various CHDs. Atrial septal defects (ASDs) were the most commonly diagnosed defect followed by ventricular septal defects (VSDs) andpulmonary stenosis. Severe CHDs had an aggregate birth prevalence of 7.4 (95% CI

Discussion

In this analysis of very and extremely premature infants born 25-32 weeks GA, the overall birth prevalence of CHDs (116/1000 births of similar GA) was significantly higher than the reported birth prevalence of CHDs in term neonates (6-10/1000 births).1, 2, 3, 4, 5 Importantly, the subset of severe CHDs were almost 5-fold more likely in very/extremely premature neonates when compared with term neonates, and very/extremely premature neonates with severe CHDs had a more than 7-fold increased odds

References (23)

  • B. Khoshnood et al.

    Prevalence, timing of diagnosis and mortality of newborns with congenital heart defects: a population-based study

    Heart

    (2012)
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    Supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (1TL1TR001116 [to P.C.] and UL1TR001117 [to J.L., C.H., K.H.]). K.H. receives funding from the Gilead Cardiovascular Scholars Research Program and is a consultant for Kowa Pharmaceuticals. The other authors declare no conflicts of interest.

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