Department of Pediatrics, University of Washington, Seattle, Washington.
Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Am J Perinatol. 2021 Nov;38(13):1366-1372. doi: 10.1055/s-0040-1712964. Epub 2020 Jun 2.
Prematurity and low birth weight (LBW) are risk factors for increased morbidity and mortality in infants with congenital heart defects (CHDs). We sought to describe survival, inhospital morbidities, and 2-year neurodevelopmental follow-up in LBW infants with CHD.
We included infants with birth weight (BW) <2,500 g diagnosed with CHD (except isolated patent ductus arteriosus) admitted January 2013 to March 2016 to a single level-IV academic neonatal intensive care unit. We reported CHD prevalence by BW and gestational age; selected in-hospital morbidities and mortality by infant BW, CHD type, and surgical intervention; and developmental outcomes by Bayley's scales of infant and toddler development, third edition (BSID-III) scores at age 2 years.
Among 420 infants with CHD, 28 (7%) underwent cardiac surgery. Median (25th and 75th percentiles) gestational age was 30 (range: 27-33) weeks and BW was 1,258 (range: 870-1,853) g. There were 134 of 420 (32%) extremely LBW (<1,000 g) infants, 82 of 420 (20%) were small for gestational age, and 51 of 420 (12%) multiples. Most common diagnosis: atrial septal defect (260/420, 62%), followed by congenital anomaly of the pulmonary valve (75/420, 18%). Most common surgical procedure: pulmonary artery banding (5/28, 18%), followed by the tetralogy of Fallot corrective repair (4/28, 14%). Survival to discharge was 88% overall and lower among extremely LBW (<1,000 g, 81%) infants and infants undergoing surgery (79%). Comorbidities were common (35%); retinopathy of prematurity and bronchopulmonary dysplasia were most prevalent. BSID-III scores were available on 148 of 176 (84%); any scores <85 were noted in 73 of 148 (49%), with language being most commonly affected.
Among LBW infants with congenital heart disease, hospital mortality varied by BW and cardiac diagnosis.
· In low birth weight infants with congenital heart disease, survival varied by birth weight and cardiac diagnosis.. · Overall survival was higher than previously reported.. · There were fewer morbidities than previously reported.. · Bayley's scale-III scores at 2 years of age were <85 for nearly half..
早产和低出生体重（LBW）是患有先天性心脏病（CHD）的婴儿发病率和死亡率增加的危险因素。我们旨在描述 LBW 合并 CHD 婴儿的存活率、住院期并发症和 2 年神经发育随访结果。
我们纳入了 2013 年 1 月至 2016 年 3 月在一家四级学术新生儿重症监护病房住院、出生体重（BW）<2500g 且诊断为 CHD（除单纯动脉导管未闭）的婴儿。我们按 BW 和胎龄报告 CHD 发生率；按 BW、CHD 类型和手术干预选择住院期并发症和死亡率；并按贝利婴幼儿发育量表第三版（BSID-III）评分评估 2 岁时的发育结果。
在 420 例 CHD 婴儿中，28 例（7%）接受了心脏手术。中位（25%和 75%分位数）胎龄为 30 周（范围：27-33 周），BW 为 1258g（范围：870-1853g）。420 例婴儿中有 134 例（32%）极低出生体重（<1000g），82 例（20%）为小于胎龄儿，51 例（12%）为多胎。最常见的诊断为房间隔缺损（260/420，62%），其次是肺动脉瓣畸形（75/420，18%）。最常见的手术为肺动脉带环术（5/28，18%），其次是法洛四联症矫正修复术（4/28，14%）。总体存活率为 88%，极低出生体重（<1000g）婴儿和接受手术婴儿的存活率较低（分别为 81%和 79%）。合并症常见（35%），其中以早产儿视网膜病变和支气管肺发育不良最为常见。176 例中有 148 例（84%）可获得贝利婴幼儿发育量表第三版评分，148 例中有 73 例（49%）评分<85，其中以语言障碍最为常见。
在 LBW 合并先天性心脏病的婴儿中，院内死亡率因 BW 和心脏诊断而异。
