548 - Do antenatal/preoperative factors predict the outcome of preterm newborns with biventricular complex congenital heart defects post-surgical intervention?

Poster Number: 548
Publication Number: 548.3149

Background: Preterm newborns with complex congenital heart defects (CCHD) who underwent open heart surgery have higher mortality and poorer long term neurodevelopmental outcomes compared to their term counterparts. We and others previously reported risk factors and outcomes in preterm and term neonates with CCHD and open heart surgery. It is known that single ventricular cardiac lesions and syndromic conditions are strongly related to adverse outcomes. However, literature is lacking on the association between outcomes in early childhood and antenatal risk factors including maternal health and delivery modes.

Objective: We aimed to explore whether antenatal/preoperative factors predict disability-free survival of preterm newborns with biventricular CCHD.

Design/Methods: Using the designed database of Complex Pediatric Therapies Follow Up Program, we retrospectively reviewed the hospital charts of mothers and all newborns, born before 37 weeks gestational age (GA) between 1997-2019, who had open heart surgery at < 6 weeks corrected age for biventricular CCHD. The surviving children had multidisciplinary comprehensive neurodevelopmental assessments between 18-24 months corrected age. Data collected included demographics, anthropometrics, acute-care clinical data, survival and disability including cerebral palsy, visual impairment, permanent hearing loss; cognitive, language and motor delays using Bayley Scales of Infant and Toddler Development, 2nd (BSID II) and 3rd edition (Bayley III). Predictors of mortality, disability, survival without disability and scores were assessed using univariate and multivariate analyses.

Results: During the study period, 84 preterm newborns with biventricular CCHD (35 +1.9 weeks GA, 2343 + 620 g, 59% males) had open heart surgery at < 6 weeks of age. Among them, 8 (9.5%) died by 2 years of age; 69 (82.1%) survived without disability and 7 (8.3%) with disability. Univariate and multivariate analysis showed predictors of clinical (Table 1) and neurodevelopmental outcomes (Table 2). Mode of delivery and labor onset were not found to be significant predictors of death or disability.

Conclusion(s): Preterm newborns with biventricular CCHD were more likely to survive up to 2 years of age without disability in the absence of premature rupture of membranes and chorioamnionitis if they did not require CPR. Maternal diabetes and birth head circumference predicted cognitive, language and motor neurodevelopmental function in early childhood. Being inborn at a tertiary hospital predicted better cognitive and language outcomes. Further prospective studies are needed to confirm these findings.