177 - Neonatal Outcomes Among Premature Infants with Congenital Heart Disease: A Multicenter Analysis

Poster Number: 177
Publication Number: 177.2862

Background: Premature infants with congenital heart disease (CHD) are a uniquely vulnerable population with high risk for negative outcomes. In the United States, this population remains understudied and data regarding morbidity and mortality in the current era are lacking.

Objective: To describe contemporary morbidity and mortality outcomes for premature infants with CHD

Design/Methods: Neonates born between 2010-2022, below 35 weeks gestational age (wGA), and with CHD and/or arrhythmias were identified within the Children’s Hospitals Neonatal Database (CHND), a multicenter collaborative of 46 Level IV neonatal intensive care units in North America. Cardiac lesions were classified into four subtypes: compromised systemic output, sustained cyanosis, congestive heart failure (CHF), and arrhythmias (Table 1). Data analysis used Chi-square and Fisher's Exact to test for association between categorical variables, and Kruskal-Wallis to test the difference in distribution across groups of the continuous variables.

Results: 11,221 preterm infants fit the inclusion criteria, of which 2701 (24%) were < 27 wGA, 2289 (20%) 27-29 wGA, 2859 (25%) 30-32 wGA, and 3372 (30%) 33-34 wGA. The largest cardiac subtype was CHF (n=7148, 63.7%), followed by sustained cyanosis (n=1820, 16.2%), arrythmias (n=1204, 10.7%), and lastly compromised systemic output (n=1049, 9.3%). Mortality was higher in patients with compromised systemic output (23.7%, n=249) relative to other subtypes (p < 0.001). Severe retinopathy of prematurity (ROP), severe intraventricular hemorrhage (sIVH, grade III-IV) and necrotizing enterocolitis (NEC, inclusive of medical and surgical subtypes) were most prevalent in the youngest GA subgroup, affecting 25% (n=665), 17.6% (n=476), and 16.4% (n=444) of neonates < 27 wGA (p < 0.001 for all), respectively. NEC and bronchopulmonary dysplasia (BPD) were most common in those with CHF, affecting 10.4% (n=745) and 11.5% (n=825), respectively (p < 0.001 for both). Compared to all neonates < 35 wGA in the CHND over the same study period, mortality was higher in this CHD cohort (12.4% v 8.2%), as were rates of severe BPD (23.4% v 15.4%), NEC (9.6% v 4.4%), and sIVH (12.8% v 11.6%) (Table 2).

Conclusion(s): Among preterm neonates, the presence of CHD leads to increased mortality and morbidity. Further work is necessary to identify mechanisms to optimize care and outcomes.