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THE EFFECT OF BIRTH WEIGHT ON MORTALITY IN INFANTS WITH CRITICAL CONGENITAL HEART DISEASE
Journal article   Open access   Peer reviewed

THE EFFECT OF BIRTH WEIGHT ON MORTALITY IN INFANTS WITH CRITICAL CONGENITAL HEART DISEASE

Martina Steurer, Edmund Burke, Scott Oltman, Rebecca Baer, Kelli Ryckman, Randi Paynter, Liang Liang, Molly McCarthy, Sky Feuer, Christina Chambers, …
Journal of the American College of Cardiology, Vol.71(11), pp.A629-A629
03/2018
DOI: 10.1016/S0735-1097(18)31170-7
url
https://doi.org/10.1016/S0735-1097(18)31170-7View
Published (Version of record) Open Access

Abstract

Background Infants with critical congenital heart disease (CCHD) are more likely to have fetal growth restriction and subsequently be small for gestational age (SGA) at birth. While SGA infants with CCHD are known to have poor postnatal outcomes, birth weight (BW) has only been evaluated as a dichotomous variable and its interaction with gestational age (GA) has not been studied. We investigated the effect of BW normalized for GA on mortality separately in term (>37 wks GA) and preterm (<37 wks GA) infants with CCHD. Methods We used a population-based database maintained by the California Office of Statewide Health Planning and Development containing detailed information on infant characteristics derived from linked hospital discharge records and birth and death certificates of all live born infants in California born 2007-2012. We included all infants with CCHD and GA 22-40 weeks without chromosomal anomalies. Our primary predictor was z-score for birth weight as a categorical vairable and the outcome was 1-year mortality. We used logistic regression and adjusted for gender, multiple gestation, GA in weeks and severity of heart defect. Results are presented in adjusted odds ratios (aOR) and 95% confidence intervals (CI). Results We identified 6570 live born infants with CCHD; 17% were SGA and 10.1% were large for GA. For preterm infants, only a z-score for BW < -2 was associated with increased mortality (aOR 2.15, 95% CI 1.1-4.21) compared to the reference group (z-score 0 to 0.5). In contrast, in term infants the aORs for z-scores < -2, -2 to -1 and -1 to -0.5 were 3.56 (95% CI 2.40-5.23), 1.63 (95% CI 1.20-2.23) and 1.45 (95% CI 1.06-1.99) vs. reference group. A z-score above 0.5 was not associated with increased mortality in preterm and term infants. Conclusion The effect of fetal growth restriction on mortality seems to be different in preterm versus term infants with CCHD. Interestingly, in preterm infants, only severe growth restriction (z-score < -2) was associated with mortality while in term infants also moderate to mild growth restriction (z-score <-0.5) was associated with poor outcome. This information has potential implications on management of these high-risk infants and counseling of parents.

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