179 - Gastrointestinal Considerations in Preterm Infants with Congenital Heart Disease: Lessons from a National Neonatal Database

Poster Number: 179
Publication Number: 179.2830

Background: Both congenital heart disease (CHD) and prematurity represent risk factors for gastrointestinal (GI) pathology, poor postnatal growth, and impaired oral feeding. While premature infants with CHD are known to be at particularly high risk for adverse outcomes, little is known about specific factors confounding their management, feeding practices and growth outcomes.

Objective: To describe GI implications, early growth and nutritional status in infants born with CHD < 35-weeks gestational age (GA), stratified by CHD physiology.

Design/Methods: A retrospective cohort study of infants with CHD born at < 35-weeks GA between 2010-2022 from the Children’s Hospital Neonatal Consortium (CHNC), a national multicenter collaborative of 46 Level IV neonatal intensive care units in North America. Data was evaluated across four CHD categories: compromised systemic output (CSO), sustained cyanosis (SC), congestive heart failure (CHF), and congenital arrhythmias (CA) (Table 1). Statistical analysis was performed using Chi-square and Fisher's Exact Tests for categorical variables and Kruskal-Wallis for continuous variables using SAS Enterprise Guide v. 8.3 at a significance level of 0.05.

Results: We identified 11,221 neonates with CHD born < 35-weeks GA. The most common cardiac diagnosis was CHF (n=7148, 63.7%), followed by SC (n=1820, 16.2%), CA (n=1204, 8.5%) and CSO (n=1049, 9.3%). Small for GA status at birth was present in 20% of the cohort and was more prevalent in CSO, SC and CHF (18.7%-27%) than in CA (8.5%), (p <.001). The second most common major non-cardiac structural anomaly was GI (12.8%), particularly bowel atresia (5.7%). Necrotizing enterocolitis (NEC) prevalence was 10%, with highest rates in CHF (10.7%) and SC groups (10.2%), (p <.001). GI procedures were the most common non-cardiac surgical interventions, led by gastrostomy tube placement (15.9%). Overall cohort mortality was 12.4%. GI/Intra-abdominal catastrophe accounted for 7.2% of deaths. Gastric tube feedings at 28 days were lower in CA compared to the other groups (p <.001). At discharge, 37.8% of the cohort required some form of tube feedings with the prevalence being higher in CSO (51.6%), SC (42.2%), and CHF (38.6%) compared to CA (20.6%), (p <.001).

Conclusion(s): In a large multicenter, national cohort of premature neonates with CHD, those with CSO, SC and CHF were more likely to be SGA, require gastric feeding supplementation at 28 days and at time of discharge. GI comorbidities are common in the premature infant with CHD and the most common reason for non-cardiac surgical interventions.