Mortality and Major Neonatal Morbidity in Preterm Infants with Serious Congenital Heart Disease,The Journal of Pediatrics

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Mortality and Major Neonatal Morbidity in Preterm Infants with Serious Congenital Heart Disease
The Journal of Pediatrics ( IF 5.1 ) Pub Date : 2021-08-26 , DOI: 10.1016/j.jpeds.2021.08.039
Martina A Steurer ₁ , Rebecca J Baer ₂ , Christina D Chambers ₃ , Jean Costello ₄ , Linda S Franck ₅ , Safyer McKenzie-Sampson ₄ , Tania L Pacheco-Werner ₆ , Satish Rajagopal ₇ , Elizabeth E Rogers ₈ , Larry Rand ₅ , Laura L Jelliffe-Pawlowski ₄ , Shabnam Peyvandi ₉

Affiliation

Department of Pediatrics, University of California San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA.
California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA; Department of Pediatrics, University of California San Diego, La Jolla, CA; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA.
Department of Pediatrics, University of California San Diego, La Jolla, CA.
Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA.
California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA.
California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA; Central Valley Health Policy Institute, California State University Fresno, Fresno, CA.
Department of Pediatrics, University of California San Francisco, San Francisco, CA.
Department of Pediatrics, University of California San Francisco, San Francisco, CA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA.
Department of Pediatrics, University of California San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.

Objective

To investigate the trends of 1-year mortality and neonatal morbidities in preterm infants with serious congenital heart disease (CHD).

Study design

This cohort study used a population-based administrative dataset of all liveborn infants of 26-36 weeks gestational age with serious CHD born in California between 2011 and 2017. We assessed 1-year mortality and major neonatal morbidities (ie, retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage grade >2, and periventricular leukomalacia) across the study period and compared these outcomes with those in infants without CHD.

Results

We identified 1921 preterm infants with serious CHD. The relative risk (RR) of death decreased by 10.6% for each year of the study period (RR, 0.89; 95% CI, 0.84-0.95), and the RR of major neonatal morbidity increased by 8.3% for each year (RR, 1.08; 95% CI, 1.02-1.15). Compared with preterm neonates without any CHD (n = 234 522), the adjusted risk difference (ARD) for mortality was highest at 32 weeks of gestational age (9.7%; 95% CI, 8.3%-11.2%), that for major neonatal morbidity was highest at 28 weeks (21.9%; 95% CI, 17.0%-26.9%), and that for the combined outcome was highest at 30 weeks (26.7%; 95% CI, 23.3%-30.1%).

Conclusions

Mortality in preterm neonates with serious CHD decreased over the last decade, whereas major neonatal morbidities increased. Preterm infants with a gestational age of 28-32 weeks have the highest mortality or morbidity compared with their peers without CHD. These results support the need for specialized and focused medical neonatal care in preterm neonates with serious CHD.

中文翻译：

患有严重先天性心脏病的早产儿的死亡率和主要新生儿发病率

客观的

调查患有严重先天性心脏病（CHD）的早产儿 1 年死亡率和新生儿发病率的趋势。

学习规划

这项队列研究使用了 2011 年至 2017 年间在加利福尼亚州出生的所有 26-36 周胎龄、患有严重先心病的活产婴儿的基于人群的管理数据集。我们评估了 1 年死亡率和主要新生儿发病率（即早产儿视网膜病变、支气管肺疾病）整个研究期间的发育不良、坏死性小肠结肠炎、脑室内出血>2 级和脑室周围白质软化），并将这些结果与无 CHD 的婴儿进行比较。

结果

我们发现 1921 名早产儿患有严重的先心病。研究期间，死亡相对风险 (RR) 每年下降 10.6%（RR，0.89；95% CI，0.84-0.95），主要新生儿发病率 RR 每年增加 8.3%（RR，0.89；95% CI，0.84-0.95）。 1.08；95% CI，1.02-1.15）。与没有任何CHD的早产儿（n = 234 522）相比，胎龄32周时死亡率的调整风险差（ARD）最高（9.7%；95% CI，8.3%-11.2%），主要新生儿的死亡率最高28周时发病率最高（21.9%；95% CI，17.0%-26.9%），30周时综合结果最高（26.7%；95% CI，23.3%-30.1%）。