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Serious congenital heart disease associated with greater mortality rates in very low birth weight infants

Archer JM. Pediatrics. 2011;doi:10.1542/peds.2010-0418.

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Regardless of other risk factors present, the very low birth weight infant population experiences greater mortality rates from serious congenital heart disease than other infants, researchers said.

Defining serious congenital heart disease as having one of 14 specific lesions or requiring surgical or medical treatment before aged 1 year, researchers reviewed a large international multicenter database of very low birth weight infants (<1,500 g; born 22-29 weeks) born or treated in a neonatal ICU from 2006 to 2007 (99,786 patients, 703 centers). Infants with nonstructural disease, as well as isolated and untreated atrial or ventricular septal defects, were excluded from the data, as were those who died in the delivery room.

Researchers found that 893 infants (8.9 per 1,000) had serious congenital heart disease. Of those, 166 (18.6%) had tetralogy of Fallot lesions, 103 (11.5%) had aortic coarctation, 73 (8.2%) had pulmonary atresia and 68 (7.6%) had double-outlet right ventricle. The mortality rate for very low birth weight infants with serious congenital heart disease was 44% vs. 12.7% for those without (P=.0001). An adjusted OR for mortality of 6.3 (95% CI, 5.2-7.7) was used.

Researchers also said extracardiac malformations occurred in 36% of very low birth weight infants with tetralogy of Fallot, 74% of those with complete atrioventricular canal, and 41% of those with double-outlet right ventricle. The highest correlation between mortality and defects were with hypoplastic left heart (85.2%) and other single-ventricle lesions (84%).

The co-occurrence of extracardiac malformations and the distribution of lesions likely affect the frequency of serious congenital heart disease in very low birth weight infants, the researchers wrote.

However, “[Very low birth weight] infants with serious [congenital heart disease] have a much higher mortality rate than those without, independent of the presence of extracardiac malformation and other variables known to affect mortality,” they concluded.

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