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Kim M, Okunowo O, Ades AM, Fuller S, Rintoul NE, Naim MY. Single-Center Comparison of Outcomes Following Cardiac Surgery in Low Birth Weight and Standard Birth Weight Neonates. J Pediatr 2021; 238:161-167.e1. [PMID: 34214588 DOI: 10.1016/j.jpeds.2021.06.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/19/2021] [Accepted: 06/23/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To compare outcomes between low birth weight (LBW; <2.5 kg) and standard birth weight neonates undergoing cardiac surgery. STUDY DESIGN A single-center retrospective study of neonates undergoing cardiac surgery with cardiopulmonary bypass from 2012 to 2018. LBW neonates were 1:2 propensity score-matched to standard birth weight neonates (n = 93 to n = 186) using clinical characteristics. The primary and secondary outcomes were survival to hospital discharge and postoperative complications, respectively. After matching, regression analyses were conducted to compare outcomes. RESULTS The LBW group had a higher proportion of premature neonates than the standard birth weight group (60% vs 8%; P < .01) and were less likely to survive to hospital discharge (88% vs 95%; OR, 0.39; 95% CI, 0.15-0.97). There was no difference in unplanned cardiac reoperations or catheter-based interventions, cardiac arrest, extracorporeal membrane oxygenation, infection, and end-organ complications between the groups. Among LBW infants, survival was improved at weight >2 kg. CONCLUSIONS LBW is a risk factor for decreased survival. LBW neonates weighing >2 kg have survival comparable to those weighing >2.5 kg.
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Affiliation(s)
- Minso Kim
- Division of Newborn Medicine, Department of Pediatrics, Mount Sinai Kravis Children's Hospital, New York, NY.
| | - Oluwatimilehin Okunowo
- Data Science & Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Anne M Ades
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Stephanie Fuller
- Division of Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Natalie E Rintoul
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Maryam Y Naim
- Division of Cardiac Critical Care, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Hyperlactataemia as a predictor of adverse outcomes post-cardiac surgery in neonates with congenital heart disease. Cardiol Young 2021; 31:1401-1406. [PMID: 33557993 DOI: 10.1017/s1047951121000263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the discriminative ability of hyperlactataemia for early morbidity and mortality in neonates with CHD following cardiac surgery. METHODS Retrospective, observational study of neonates who underwent cardiac surgery on cardiopulmonary bypass at a tertiary care children's hospital from June 2015 to June 2019. The primary predictor was lactate. The primary composite outcome was defined as ≥1 of the following: cardiac arrest or extracorporeal membrane oxygenation within 72 hours or 30-day mortality post-operatively. The secondary outcome was the presence of major residual lesions, according to the Technical Performance Score. RESULTS Of 432 neonates, 28 (6.5%) sustained the composite outcome. On univariate analysis, peak lactate within 48 hours, increase in lactate from ICU admission through 12 hours, and single ventricle physiology were significantly associated with the composite outcome. The peak lactate occurred at a median of 2.9 hours (interquartile range: 1, 35) before the event. Through multi-variable analysis, a multi-variable risk algorithm was created. Predicted probabilities demonstrated an increasing risk based on single ventricle status and delta lactate, ranging from 1.8% (95% CI: 0.9, 3.9) to 52.4% (95% CI: 32.4, 71.7). The model had good discriminative ability for the composite outcome on receiver operating characteristic analysis (area under the curve = 0.79; 95% CI: 0.75, 0.89). Moreover, a peak lactate of 7.3 mmol/l or greater was significantly associated with the presence of a major residual lesion (odds ratios: 5.16, 95% CI: 3.01, 8.87). CONCLUSIONS We present a simple, two-variable model, including delta lactate in the immediate post-operative period and single ventricle status, to prognosticate the risk of early morbidity and mortality in neonates undergoing cardiac surgery for potential intervention.
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Sun HY. Prenatal diagnosis of congenital heart defects: echocardiography. Transl Pediatr 2021; 10:2210-2224. [PMID: 34584892 PMCID: PMC8429868 DOI: 10.21037/tp-20-164] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/07/2020] [Indexed: 12/22/2022] Open
Abstract
Congenital heart defects (CHD) are the most common congenital anomaly, and the majority can be diagnosed during prenatal life. Prenatal detection rates remain highly variable, as most CHD occur in low risk pregnancies and therefore depend on the maternal obstetric provider to recognize fetal cardiac abnormality on obstetric screening anatomic ultrasound. Fetuses with abnormal findings on obstetric screening anatomic ultrasound and/or risk factors for cardiac disease should be referred for evaluation with fetal echocardiography. Fetal echocardiography should be performed by specialized sonographers and interpreted by physicians with knowledge of evolving fetal cardiac anatomy and physiology throughout gestation. A fetal echocardiography examination, which can be done from the late first trimester onward, utilizes a standardized and systemic approach to diagnose fetuses with CHD or other forms of primary or secondary cardiac disease. The field of fetal cardiology has advanced past the accurate prenatal diagnosis of simple and complex CHD, as fetal echocardiography enables understanding of dynamic fetal cardiac physiology and consideration of potential fetal/neonatal treatment. The greatest impact of fetal echocardiography remains identification of critical CHD before birth to allow immediate cardiac management after delivery to decrease neonatal morbidity and mortality. Analyzing the severity of abnormal cardiac physiology in various forms of CHD before birth allows the fetal cardiologist to prognosticate effects on the developing fetus, predict risk of postnatal hemodynamic instability, guide delivery planning through multidisciplinary collaboration, and anticipate how the disease will impact the neonate after delivery.
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Affiliation(s)
- Heather Y Sun
- Division of Pediatric Cardiology, Department of Pediatrics, Rady Children's Hospital, University of California, San Diego, San Diego, CA, USA
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Afshar Y, Hogan WJ, Conturie C, Sunderji S, Duffy JY, Peyvandi S, Boe NM, Melber D, Fajardo VM, Tandel MD, Holliman K, Kwan L, Satou G, Moon-Grady AJ. Multi-Institutional Practice-Patterns in Fetal Congenital Heart Disease Following Implementation of a Standardized Clinical Assessment and Management Plan. J Am Heart Assoc 2021; 10:e021598. [PMID: 34315235 PMCID: PMC8475692 DOI: 10.1161/jaha.121.021598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Prenatal diagnosis of congenital heart disease has been associated with early‐term delivery and cesarean delivery (CD). We implemented a multi‐institutional standardized clinical assessment and management plan (SCAMP) through the University of California Fetal‐Maternal Consortium. Our objective was to decrease early‐term (37–39 weeks) delivery and CD in pregnancies complicated by fetal congenital heart disease using a SCAMP methodology to improve practice in a high‐risk and clinically complex setting. Methods and Results University of California Fetal‐Maternal Consortium site‐specific management decisions were queried following SCAMP implementation. This contemporary intervention group was compared with a University of California Fetal‐Maternal Consortium historical cohort. Primary outcomes were early‐term delivery and CD. A total of 496 maternal–fetal dyads with prenatally diagnosed congenital heart disease were identified, 185 and 311 in the historical and intervention cohorts, respectively. Recommendation for later delivery resulted in a later gestational age at delivery (38.9 versus 38.1 weeks, P=0.01). After adjusting for maternal age and site, historical controls were more likely to have a CD (odds ratio [OR],1.8; 95% CI, 2.1–2.8; P=0.004) and more likely (OR, 2.1; 95% CI, 1.4–3.3) to have an early‐term delivery than the intervention group. Vaginal delivery was recommended in 77% of the cohort, resulting in 61% vaginal deliveries versus 50% in the control cohort (P=0.03). Among pregnancies with major cardiac lesions (n=373), vaginal birth increased from 51% to 64% (P=0.008) and deliveries ≥39 weeks increased from 33% to 48% (P=0.004). Conclusions Implementation of a SCAMP decreased the rate of early‐term deliveries and CD for prenatal congenital heart disease. Development of clinical pathways may help standardize care, decrease maternal risk secondary to CD, improve neonatal outcomes, and reduce healthcare costs.
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Affiliation(s)
- Yalda Afshar
- Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology University of California Los Angeles CA
| | - Whitnee J Hogan
- Division of Pediatric Cardiology Department of Pediatrics University of California San Francisco CA
| | - Charlotte Conturie
- Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology University of California San Diego CA
| | - Sherzana Sunderji
- Division of Pediatric Cardiology Department of Pediatrics University of California Davis CA
| | - Jennifer Y Duffy
- Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology University of California Irvine CA
| | - Shabnam Peyvandi
- Division of Pediatric Cardiology Department of Pediatrics University of California San Francisco CA
| | - Nina M Boe
- Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology University of California Davis CA
| | - Dora Melber
- Department of Urology University of California Los Angeles CA
| | - Viviana M Fajardo
- Division of Neonatology Department of Pediatrics University of California Los Angeles CA
| | - Megha D Tandel
- Department of Urology University of California Los Angeles CA
| | - Kerry Holliman
- Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology University of California Los Angeles CA
| | - Lorna Kwan
- Department of Urology University of California Los Angeles CA
| | - Gary Satou
- Division of Pediatric Cardiology Department of Pediatrics University of California Los Angeles CA
| | - Anita J Moon-Grady
- Division of Pediatric Cardiology Department of Pediatrics University of California San Francisco CA
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Hazekamp MG, Barron DJ, Dangel J, Homfray T, Jongbloed MRM, Voges I. Consensus document on optimal management of patients with common arterial trunk. Eur J Cardiothorac Surg 2021; 60:7-33. [PMID: 34017991 DOI: 10.1093/ejcts/ezaa423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/18/2020] [Accepted: 09/30/2020] [Indexed: 01/12/2023] Open
Affiliation(s)
- Mark G Hazekamp
- Department of Cardiothoracic Surgery, University Hospital Leiden, Leiden, Netherlands
| | - David J Barron
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Joanna Dangel
- Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Tessa Homfray
- Department of Medical Genetics, Royal Brompton and Harefield hospitals NHS Trust, London, UK
| | - Monique R M Jongbloed
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Inga Voges
- Department for Congenital Cardiology and Pediatric Cardiology, University Medical Center of Schleswig-Holstein, Kiel, Germany
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Wan J, Zhong X, Xu Z, Gong D, Li D, Xin Z, Ma X, Li W. A decellularized porcine pulmonary valved conduit embedded with gelatin. Artif Organs 2021; 45:1068-1082. [PMID: 33730379 DOI: 10.1111/aor.13955] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/27/2021] [Accepted: 03/11/2021] [Indexed: 11/27/2022]
Abstract
To prepare a tissue-engineered pulmonary valved conduit (PVC) with good tensile strength and biocompatibility. Sixty adult porcine PVCs were used to determine the optimal decellularization time. Five juvenile porcine decellularized PVCs and five juvenile porcine crosslinked PVCs were subsequently prepared according to the optimized decellularization and crosslinking methods. All PVCs were implanted into juvenile sheep for 8 months and then were harvested for staining. With a low concentration of detergent (0.25% Triton X-100+0.25% sodium deoxycholate), the decellularization effect on porcine PVCs was complete by 24 hours, and there was minimal damage to the matrix. Gelatin embedding and 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) crosslinking improved the biomechanical properties of decellularized PVCs and reduced their immunogenicity. After implantation, the diameter and thickness of the PVCs in the decellularized and crosslinked groups increased significantly. In both groups, the conduits were unobstructed, with soft and smooth inner walls and without thrombosis, ulceration or neoplasia. The valves slightly degenerated with mild to moderate regurgitation. CD31-positive endothelial cells were visible on the inner surface of the conduits and valves. Scattered smooth muscle actin-positive cells were found in the middle layer of the conduit. The percentage of CD4- and CD68-positive cells and the calcium content were highest in decellularized porcine PVCs and lowest in ovine PVCs. The percentage of the matrix that was laminin-positive in decellularized and crosslinked porcine PVCs was lower than it was in ovine PVCs. Gelatin-embedded and EDC-crosslinked porcine PVCs can be "hosted" in sheep, with good biocompatibility, growth potential, and reduced calcification.
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Affiliation(s)
- Juyi Wan
- Department of Cardiovascular Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, P.R. China.,Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, P.R. China.,Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, P.R. China.,Key Laboratory of Medical Electrophysiology, Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, (Collaborative Innovation Center for Prevention of Cardiovascular Diseases) Institute of Cardiovascular Research, Southwest Medical University, Luzhou, P.R. China
| | - Xiaolin Zhong
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, P.R. China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, P.R. China
| | - Zhiwei Xu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, P.R. China
| | - Da Gong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, P.R. China
| | - Diankun Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, P.R. China
| | - Zhifei Xin
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, P.R. China
| | - Xiaolong Ma
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, P.R. China
| | - Wenbin Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, P.R. China
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Matthiesen NB, Østergaard JR, Hjortdal VE, Henriksen TB. Reply. J Pediatr 2021; 230:273-274. [PMID: 33253735 DOI: 10.1016/j.jpeds.2020.11.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Niels B Matthiesen
- Perinatal Epidemiology Research Unit, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus; Department of Pediatrics and Adolescent Medicine, Randers Regional Hospital, Randers
| | - John R Østergaard
- Center for Rare Diseases, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus
| | - Vibeke E Hjortdal
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus; Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen
| | - Tine B Henriksen
- Perinatal Epidemiology Research Unit, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3059] [Impact Index Per Article: 1019.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Freud LR, Wilkins-Haug LE, Beroukhim RS, LaFranchi T, Phoon CK, Glickstein JS, Cumbermack KM, Makhoul M, Morris SA, Sun HY, Ferrer Q, Pedra SR, Tworetzky W. Effect of In Utero Non-Steroidal Anti-Inflammatory Drug Therapy for Severe Ebstein Anomaly or Tricuspid Valve Dysplasia (NSAID Therapy for Fetal Ebstein anomaly). Am J Cardiol 2021; 141:106-112. [PMID: 33217351 DOI: 10.1016/j.amjcard.2020.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/02/2020] [Accepted: 11/06/2020] [Indexed: 10/23/2022]
Abstract
Ebstein anomaly (EA) and tricuspid valve dysplasia (TVD) are rare congenital malformations associated with nearly 50% mortality when diagnosed in utero. The diseases often produce severe tricuspid regurgitation (TR) in the fetus and in some cases, pulmonary regurgitation (PR) and circular shunting ensue. Since the ductus arteriosus (DA) plays a critical role in the circular shunt and may be constricted by transplacental nonsteroidal anti-inflammatory drugs (NSAIDs), we sought to assess the effect of NSAIDs on fetuses with EA/TVD. We reviewed mothers of singleton fetuses with EA/TVD and PR, indicative of circular shunting, who were offered NSAIDs at multiple centers from 2010 to 2018. Initial dosing consisted of indomethacin, followed by ibuprofen in most cases. Twenty-one patients at 10 centers were offered therapy at a median gestational age (GA) of 30.0 weeks (range: 20.9 to 34.9). Most (15/21 = 71%) mothers received NSAIDs, and 12 of 15 (80%) achieved DA constriction after a median of 2.0 days (1.0 to 6.0). All fetuses with DA constriction had improved PR; 92% had improved Doppler patterns. Median GA at pregnancy outcome (live-birth or fetal demise) was 36.1 weeks (30.7 to 39.0) in fetuses with DA constriction versus 33 weeks (23.3 to 37.3) in fetuses who did not receive NSAIDs or achieve DA constriction (p = 0.040). Eleven of 12 patients (92%) with DA constriction survived to live-birth, whereas 4 of 9 patients (44%) who did not receive NSAIDs or achieve DA constriction survived (p = 0.046). In conclusion, our findings demonstrate the proof of concept that NSAIDs mitigate circular shunt physiology by DA constriction and improve PR among fetuses with severe EA/TVD. Although the early results are encouraging, further investigation is necessary to determine safety and efficacy.
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Affiliation(s)
- Lindsay R Freud
- Department of Pediatrics, Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of NewYork-Presbyterian, Columbia University Medical Center, New York, New York.
| | - Louise E Wilkins-Haug
- Department of Obstetrics, Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston Massachusetts
| | - Rebecca S Beroukhim
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Terra LaFranchi
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Colin K Phoon
- Department of Pediatrics, Division of Pediatric Cardiology, Hassenfeld Children's Hospital, New York University, New York, New York
| | - Julie S Glickstein
- Department of Pediatrics, Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of NewYork-Presbyterian, Columbia University Medical Center, New York, New York
| | - Kristopher M Cumbermack
- Department of Pediatrics, Division of Pediatric Cardiology, Kentucky Children's Hospital, University of Kentucky, Lexington, Kentucky
| | - Majd Makhoul
- Department of Pediatrics, Division of Pediatric Cardiology, Kentucky Children's Hospital, University of Kentucky, Lexington, Kentucky
| | - Shaine A Morris
- Department of Pediatrics, Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Heather Y Sun
- Department of Pediatrics, Division of Pediatric Cardiology, Rady Children's Hospital, University of California-San Diego, San Diego, California
| | - Queralt Ferrer
- Department of Pediatrics, Division of Pediatric Cardiology, University Hospital Vall d'Hebron, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Simone R Pedra
- Department of Pediatrics, Division of Pediatric Cardiology, Instituto Dante Pazzanese de Cardiologia/Hospital do Coracao da Associacao Sanatorio Sirio, Sao Paulo, Brazil
| | - Wayne Tworetzky
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Commentary: The growing problem in congenital heart surgery. J Thorac Cardiovasc Surg 2021; 162:1849-1850. [PMID: 33712231 DOI: 10.1016/j.jtcvs.2021.01.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 11/23/2022]
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Analysis of factors associated with prolonged post-operative course after surgical repair of aortic coarctation. Cardiol Young 2021; 31:191-198. [PMID: 33140711 DOI: 10.1017/s1047951120003637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE We sought to describe patient characteristics associated with prolonged post-operative length of stay in a contemporary cohort of infants who underwent isolated repair of aortic coarctation. METHODS We reviewed patients less than 1 year of age who underwent isolated repair of aortic coarctation at our institution from 2009 to 2016. Prolonged post-operative length of stay was defined as length of stay within the upper tertile for the cohort. Bivariate and multi-variable analyses were performed to determine independent risk factors for prolonged length of stay. RESULTS We reviewed 95 consecutive patients who underwent isolated repair of aortic coarctation, of whom 71 were neonates at the time of diagnosis. The median post-operative length of stay was 6.5 days. The upper tertile for post-operative length of stay was greater than 10 days; 32 patients within this tertile and 1 patient who died at 8.5 days after surgery were analysed as having prolonged post-operative length of stay. In a multi-variable analysis, pre-maturity (odds ratio: 3.5, 95% confidence interval: 1.2, 10.7), genetic anomalies (odds ratio: 4.7, 95% confidence interval: 1.2, 18), absence of pre-operative oral feeding (odds ratio: 7.4, 95% confidence interval: 2.4, 22.3), and 12-hour vasoactive-ventilation-renal score greater than 25 (odds ratio: 7.4, 95% confidence interval: 1.9, 29) were independently associated with prolonged length of stay. CONCLUSIONS In neonates and infants who underwent isolated repair of aortic coarctation, pre-maturity, genetic anomalies, lack of pre-operative oral feedings, and 12-hour vasoactive-ventilation-renal score more than 25 were independent risk factors for prolonged post-operative length of stay. Further study on the relationship between pre-operative oral feedings and post-operative length of stay should be pursued.
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Matthiesen NB, Østergaard JR, Hjortdal VE, Henriksen TB. Congenital Heart Defects and the Risk of Spontaneous Preterm Birth. J Pediatr 2021; 229:168-174.e5. [PMID: 32980375 DOI: 10.1016/j.jpeds.2020.09.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To estimate the association between major types of congenital heart defects (CHD) and spontaneous preterm birth, and to assess the potential underlying mechanisms. STUDY DESIGN This nationwide, registry-based study included a cohort of all singleton pregnancies in Denmark from 1997 to 2013. The association between CHD and spontaneous preterm birth was estimated by multivariable Cox regression, adjusted for potential confounders. The following potential mechanisms were examined: maternal genetics (sibling analyses), polyhydramnios, preterm prelabor rupture of membranes, preeclampsia, and indicators of fetal and placental growth. RESULTS The study included 1 040 474 births. Compared with the general population, CHD was associated with an increased risk of spontaneous preterm birth, adjusted hazard ratio 2.1 (95% CI, 1.9-2.4). Several subtypes were associated with increased risks, including pulmonary stenosis combined with a septal defect, 5.2 (95% CI, 3.7-7.5); pulmonary stenosis or atresia, 3.1 (95% CI, 2.4-4.1); tetralogy of Fallot 2.5 (95% CI, 1.6-3.8); coarctation or interrupted aortic arch 2.2 (95% CI, 1.5-3.2); and hypoplastic left heart syndrome, 2.0 (95% CI, 1.0-4.1). Overall, preterm prelabor rupture of membranes mediated more than one-half of the association. Maternal genetics, polyhydramnios, or indicators of fetal or placental growth did not explain the reported associations. CONCLUSIONS CHD, especially right ventricular outflow tract obstructions, were associated with an increased risk of spontaneous preterm birth. The risk was carried by the CHD and not by maternal genetics. Moreover, preterm prelabor rupture of membranes was identified as a potential underlying mechanism.
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Affiliation(s)
- Niels B Matthiesen
- Perinatal Epidemiology Research Unit, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Pediatrics and Adolescent Medicine, Randers Regional Hospital, Randers, Denmark.
| | - John R Østergaard
- Center for Rare Diseases, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Vibeke E Hjortdal
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Tine B Henriksen
- Perinatal Epidemiology Research Unit, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
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Cheung PY, Hajihosseini M, Dinu IA, Switzer H, Joffe AR, Bond GY, Robertson CMT. Outcomes of Preterm Infants With Congenital Heart Defects After Early Surgery: Defining Risk Factors at Different Time Points During Hospitalization. Front Pediatr 2021; 8:616659. [PMID: 33585367 PMCID: PMC7876369 DOI: 10.3389/fped.2020.616659] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/11/2020] [Indexed: 01/28/2023] Open
Abstract
Background: Compared with those born at term gestation, infants with complex congenital heart defects (CCHD) who were delivered before 37 weeks gestational age and received neonatal open-heart surgery (OHS) have poorer neurodevelopmental outcomes in early childhood. We aimed to describe the growth, disability, functional, and neurodevelopmental outcomes in early childhood of preterm infants with CCHD after neonatal OHS. Prediction models were evaluated at various timepoints during hospitalization which could be useful in the management of these infants. Study Design: We studied all preterm infants with CCHD who received OHS within 6 weeks of corrected age between 1996 and 2016. The Western Canadian Complex Pediatric Therapies Follow-up Program completed multidisciplinary comprehensive neurodevelopmental assessments at 2-year corrected age at the referral-site follow-up clinics. We collected demographic and acute-care clinical data, standardized age-appropriate outcome measures including physical growth with calculated z-scores; disabilities including cerebral palsy, visual impairment, permanent hearing loss; adaptive function (Adaptive Behavior Assessment System-II); and cognitive, language, and motor skills (Bayley Scales of Infant and Toddler Development-III). Multiple variable logistic or linear regressions determined predictors displayed as Odds Ratio (OR) or Effect Size (ES) with 95% confidence intervals. Results: Of 115 preterm infants (34 ± 2 weeks gestation, 2,339 ± 637 g, 64% males) with CCHD and OHS, there were 11(10%) deaths before first discharge and 21(18%) deaths by 2-years. Seven (6%) neonates had cerebral injuries, 7 had necrotizing enterocolitis; none had retinopathy of prematurity. Among 94 survivors, 9% had cerebral palsy and 6% had permanent hearing loss, with worse outcomes in those with syndromic diagnoses. Significant predictors of mortality included birth weight z-score [OR 0.28(0.11,0.72), P = 0.008], single-ventricle anatomy [OR 5.92(1.31,26.80), P = 0.021], post-operative ventilation days [OR 1.06(1.02,1.09), P = 0.007], and cardiopulmonary resuscitation [OR 11.58 (1.97,68.24), P = 0.007]; for adverse functional outcome in those without syndromic diagnoses, birth weight 2,000-2,499 g [ES -11.60(-18.67, -4.53), P = 0.002], post-conceptual age [ES -0.11(-0.22,0.00), P = 0.044], post-operative lowest pH [ES 6.75(1.25,12.25), P = 0.017], and sepsis [ES -9.70(-17.74, -1.66), P = 0.050]. Conclusions: Our findings suggest preterm neonates with CCHD and early OHS had significant mortality and morbidity at 2-years and were at risk for cerebral palsy and adverse neurodevelopment. This information may be important for management, parental counseling and the decision-making process.
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Affiliation(s)
- Po-Yin Cheung
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- NICU, Northern Alberta Neonatal Program of Alberta Health Services, Edmonton, AB, Canada
| | | | - Irina A. Dinu
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | | | - Ari R. Joffe
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- PICU Stollery Children's Hospital, Edmonton, AB, Canada
| | - Gwen Y. Bond
- Complex Pediatric Therapies Developmental Assessment Clinic at the Glenrose Rehabilitation Hospital of Alberta Health Services, Edmonton, AB, Canada
| | - Charlene M. T. Robertson
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Complex Pediatric Therapies Developmental Assessment Clinic at the Glenrose Rehabilitation Hospital of Alberta Health Services, Edmonton, AB, Canada
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Steurer MA, Peyvandi S, Costello JM, Moon-Grady AJ, Habib RH, Hill KD, Jacobs ML, Jelliffe-Pawlowski LL, Keller RL, Pasquali SK, Reddy VM, Tabbutt S, Rajagopal S. Association between Z-score for birth weight and postoperative outcomes in neonates and infants with congenital heart disease. J Thorac Cardiovasc Surg 2021; 162:1838-1847.e4. [DOI: 10.1016/j.jtcvs.2021.01.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 01/12/2021] [Accepted: 01/15/2021] [Indexed: 12/17/2022]
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Hu R, Zhu H, Qiu L, Hong H, Xu Z, Zhang H, Chen H. Association Between Preoperative Factors and In-hospital Mortality in Neonates After Cardiac Surgery in China. Front Pediatr 2021; 9:670197. [PMID: 34422714 PMCID: PMC8374182 DOI: 10.3389/fped.2021.670197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 07/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Little is known about preoperative factors affecting cardiac surgery outcomes of neonates in China. We sought to examine the association between characteristics of neonates with congenital heart disease (CHD) and early postoperative outcomes after cardiac repair in a tertiary care paediatric hospital. Methods: A single-centre retrospective cohort study of neonates who underwent cardiac surgery between January 2006 and December 2019 was performed. Demographic, institutional, and surgical characteristics of neonates were examined and their association with in-hospital mortality was analysed using multivariable logistic regression models. Results: During the study period, we analysed the outcomes of 1,078 neonates. In-hospital mortality decreased to 13.8% in the era 2017-2019. The overall in-hospital mortality rate was 16.3%. Normal weight at surgery [odds ratio (OR), 0.63; 95% confidence interval (CI), 0.47-0.85; P = 0.003] was associated with lower mortality risk. Poor health status (emergent: OR, 3.11; 95% CI, 1.96-4.94; P < 0.001; elective: OR, 1.63; 95% CI, 1.11-2.40; P = 0.013), higher Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) categories (STAT 5 category: OR, 2.58; 95% CI, 1.04-6.43; P = 0.042), and limited individual surgeon experience (surgeon with 5-10 operations per year: OR, 1.43; 95% CI, 1.06-1.95; P = 0.021) were associated with higher odds of early death. Conclusion: In-hospital mortality after neonatal cardiac surgery remained high in our centre over the past 10 years. Some preoperative aspects, including low-weight at surgery, poor health status, increased surgical complexity, and limited surgeon experience were significantly associated with higher mortality. Based on the observed associations, the necessary practises to be modified, especially in preoperative care, should be identified and assessed in future research.
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Affiliation(s)
- Renjie Hu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hongbin Zhu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lisheng Qiu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Haifa Hong
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiwei Xu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Haibo Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Chen
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Rey J, Ramchandani BK, Gonzalez-Rocafort Á, Sánchez R, Polo L, Lamas MJ, Centella T, Uceda Á, López-Ortego P, Aroca Á. Cirugía cardiaca neonatal: ¿importa el peso? CIRUGIA CARDIOVASCULAR 2021. [DOI: 10.1016/j.circv.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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68
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Purkey NJ, Ma C, Lee HC, Hintz SR, Shaw GM, McElhinney DB, Carmichael SL. Timing of Transfer and Mortality in Neonates with Hypoplastic Left Heart Syndrome in California. Pediatr Cardiol 2021; 42:906-917. [PMID: 33533967 PMCID: PMC7857096 DOI: 10.1007/s00246-021-02561-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/16/2021] [Indexed: 11/30/2022]
Abstract
Maternal race/ethnicity is associated with mortality in neonates with hypoplastic left heart syndrome (HLHS). We investigated whether maternal race/ethnicity and other sociodemographic factors affect timing of transfer after birth and whether timing of transfer impacts mortality in infants with HLHS. We linked two statewide databases, the California Perinatal Quality Care Collaborative and records from the Office of Statewide Health Planning and Development, to identify cases of HLHS born between 1/1/06 and 12/31/11. Cases were divided into three groups: birth at destination hospital, transfer on day of life 0-1 ("early transfer"), or transfer on day of life ≥ 2 ("late transfer"). We used log-binomial regression models to estimate relative risks (RR) for timing of transfer and Cox proportional hazard models to estimate hazard ratios (HR) for mortality. We excluded infants who died within 60 days of life without intervention from the main analyses of timing of transfer, since intervention may not have been planned in these infants. Of 556 cases, 107 died without intervention (19%) and another 52 (9%) died within 28 days. Of the 449 included in analyses of timing of transfer, 28% were born at the destination hospital, 49% were transferred early, and 23% were transferred late. Late transfer was more likely for infants of low birthweight (RR 1.74) and infants born to US-born Hispanic (RR 1.69) and black (RR 2.45) mothers. Low birthweight (HR 1.50), low 5-min Apgar score (HR 4.69), and the presence of other major congenital anomalies (HR 3.41), but not timing of transfer, predicted neonatal mortality. Late transfer was more likely in neonates born to US-born Hispanic and black mothers but was not associated with higher mortality.
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Affiliation(s)
- Neha J. Purkey
- Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, USA
| | - Chen Ma
- Division of Neonatology and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, USA
| | - Henry C. Lee
- Division of Neonatology and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, USA
| | - Susan R. Hintz
- Division of Neonatology and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, USA
| | - Gary M. Shaw
- Division of Neonatology and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, USA
| | - Doff B. McElhinney
- Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, USA ,Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, USA
| | - Suzan L. Carmichael
- Division of Neonatology and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, USA ,Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, USA
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69
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Namachivayam SP. Fetal maturation and neonatal cardiac surgery: categorizing gestational age is inadvisable. Ann Thorac Surg 2020; 112:1516-1517. [PMID: 33279551 DOI: 10.1016/j.athoracsur.2020.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/04/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Siva P Namachivayam
- Cardiac Intensive Care Unit, Royal Children's Hospital Melbourne, 50 Flemington Rd, Melbourne VIC 3052, Australia.
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70
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Gunasekara CM, Moynihan K, Sudhakar A, Sunil GS, Kotayil BP, Bayya PR, Kumar RK. Neonatal cardiac surgery in low resource settings: implications of birth weight. Arch Dis Child 2020; 105:1140-1145. [PMID: 32718929 DOI: 10.1136/archdischild-2020-319161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/31/2020] [Accepted: 06/22/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We sought to evaluate the association between low birth weight (LBW) and outcomes following neonatal cardiac surgery in a low-income and middle-income country setting where LBW prevalence is high and its impact on surgical outcomes is undefined. DESIGN Single-centre retrospective cohort study. SETTING Referral paediatric hospital in Southern India PATIENTS: All neonatal cardiac surgical cases between January 2011 and December 2018. LBW was defined as <2.5 kg. MAIN OUTCOME MEASURES Patient demographics, corrective versus palliative surgery and postoperative outcomes were collected from the institutional database which undergoes regular audit as part of International Quality Improvement Collaborative for Congenital Heart Disease. In-hospital mortality was the primary outcome measure. RESULTS Of 569 neonatal cardiac operations, 123 (21.6%) had LBW (mean: 2.2±0.3 kg); 18.7% <2 kg and 21.1% were preterm (<37 weeks). Surgery type (corrective vs palliative) or non-cardiac anomalies were not associated with birth weight. Birth weight did not correlate with ICU length of stay (LOS) and mechanical ventilation but was lower in those with postoperative sepsis. Overall in-hospital mortality was 7.0%; LBW neonates had higher mortality (OR 2.16, 95% CI 1.09 to 4.29, p=0.025). Multivariable analyses revealed birth weight (OR per 100 g decrease in weight: 1.12; 95% CI 1.03 to 1.22), age at surgery (OR per day increase in age of 0.93; 95% CI 0.87 to 0.99) and palliative intervention (OR 4.46 (95% CI 1.91 to 10.44) as independent predictors of in-hospital mortality. CONCLUSION LBW adversely impacts in-hospital mortality outcomes following neonatal cardiac surgery in a resource-limited setting without increase in ICU or hospital LOS.
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Affiliation(s)
- Chamith Mendis Gunasekara
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - Katie Moynihan
- Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Abish Sudhakar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - Gopalraj Sumangala Sunil
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - Brijesh P Kotayil
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - Praveen Reddy Bayya
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - Raman Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
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71
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Anderson BR, Blancha Eckels VL, Crook S, Duchon JM, Kalfa D, Bacha EA, Krishnamurthy G. The Risks of Being Tiny: The Added Risk of Low Weight for Neonates Undergoing Congenital Heart Surgery. Pediatr Cardiol 2020; 41:1623-1631. [PMID: 32729052 PMCID: PMC7704774 DOI: 10.1007/s00246-020-02420-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/18/2020] [Indexed: 11/29/2022]
Abstract
The aims of this study were (1) to describe the additive risk of performing cardiac surgery in neonates born ≤ 2.0 kg, after accounting for the baseline risks of low birth weight, and (2) to describe the additive risk of being born ≤ 2.0 kg in neonates undergoing cardiac surgery. We used a risk difference analysis in a retrospective cohort, 2006-2016. Neonates born ≤ 2.0 kg undergoing congenital heart surgery during initial postnatal admission were included. Data were standardized alternatingly for birth weight and cardiac surgical risk using national population data to estimate the number of deaths expected had they not required cardiac surgery or were they of normal weight. Of 105 neonates ≤ 2 kg, median birth weight was 1.6 kg (IQR 1.3-1.8 kg). Median gestational age was 33 weeks (IQR 31-35 weeks). Observed operative mortality was 14.3%; 0% for neonates ≤ 1.0 kg (CI 0-33.6%), 20.6% for neonates > 1.0-1.5 kg (CI 8.7-37.9%), and 12.9% for neonates > 1.5-2.0 kg (CI 5.7-23.9%). Among neonates ≤ 2.0 kg not undergoing cardiac surgery, expected mortality was 4.8% (CI 1.6-10.8); cardiac surgery increased the risk of mortality 9.5% (CI 1.7-17.4%). Conversely, the expected risk for normal birth weight neonates undergoing cardiac surgery was 5.7% (CI 2.1-12.0%); low birth weight increased the risk of mortality 8.6% (CI 0.5-16.6%). To continue making advancements in cardiac surgery, we must understand that the rate of mortality observed in normal weight infants is not a realistic target and that, despite advances, the risk attributable to the surgery remains higher among low birth weight patients.
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Affiliation(s)
- Brett R Anderson
- Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, 3959 Broadway, CH-2N, New York, NY, 10032, USA.
| | | | - Sarah Crook
- Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, New York, NY
| | - Jennifer M Duchon
- Division of Neonatology, NewYork-Presbyterian/Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, New York, NY
| | - David Kalfa
- Division of Cardiothoracic Surgery, NewYork-Presbyterian/Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, New York, NY
| | - Emile A Bacha
- Division of Cardiothoracic Surgery, NewYork-Presbyterian/Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, New York, NY
| | - Ganga Krishnamurthy
- Division of Neonatology, NewYork-Presbyterian/Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, New York, NY
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Krishnamurthy G, Sahni R, Leone T, Kim F, Brooks MC, Morales SV, Koziakova A, Mills C, Capaci CP, Penn A. Care of the COVID-19 exposed complex newborn infant. Semin Perinatol 2020; 44:151282. [PMID: 32819725 PMCID: PMC7373040 DOI: 10.1016/j.semperi.2020.151282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
As we confront COVID-19, the global public health emergency of our times, new knowledge is emerging that, combined with information from prior epidemics, can provide insights on how to manage this threat in specific patient populations. Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), both caused by coronaviruses, caused serious respiratory illness in pregnant women that resulted in adverse perinatal outcomes. Thus far, COVID-19 appears to follow a mild course in the vast majority of pregnant women. A significant proportion of pregnant women appear to be asymptomatic carriers of SARS-CoV-2. However, there is limited information on how COVID-19 impacts the fetus and whether vertical transmission occurs. While these knowledge gaps are addressed, it is important to recognize the highly efficient transmission characteristics of SARS-C0V-2 and its potential for causing serious disease in vulnerable individuals, including health care workers. This review provides perspectives from a single center in New York City, the epicenter of the pandemic within the United States. It offers an overview of the preparations required for deliveries of newborns of mothers with COVID-19 and the management of neonates with particular emphasis on those born with complex issues.
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Affiliation(s)
- Ganga Krishnamurthy
- Division of Neonatology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY.
| | - Rakesh Sahni
- Division of Neonatology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| | - Tina Leone
- Division of Neonatology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| | - Faith Kim
- Division of Neonatology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| | - Maria Cristina Brooks
- Division of Nursing, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| | - Sylvia Villaraza- Morales
- Division of Nursing, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| | - Adriana Koziakova
- Division of Nursing, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| | - Cloyde Mills
- Division of Nursing, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| | - Chaundra Passehl Capaci
- Division of Nursing, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| | - Anna Penn
- Division of Neonatology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
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73
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Savorgnan F, Elhoff JJ, Guffey D, Axelrod D, Buckley JR, Gaies M, Ghanayem NS, Lasa JJ, Shekerdemian L, Tweddell JS, Werho DK, Yeh J, Steurer MA. Relationship Between Gestational Age and Outcomes After Congenital Heart Surgery. Ann Thorac Surg 2020; 112:1509-1516. [PMID: 33080235 DOI: 10.1016/j.athoracsur.2020.08.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous studies suggest that birth before 39 weeks' gestational age (GA) is associated with higher perioperative mortality and morbidity after congenital heart surgery. The optimal approach to timing of cardiac operation in premature infants remains unclear. We investigated the impact of GA at birth and corrected GA at surgery on postoperative outcomes using the Pediatric Cardiac Critical Care Consortium (PC4) database. METHODS Infants undergoing selected index cardiac operations before the end of the neonatal period were included (n = 2298). GA at birth and corrected GA at the time of the index cardiac operation were used as categorical predictors and fitted as a cubic spline to assess nonlinear relationships. The primary outcome was hospital mortality. Multivariable logistic regression models assessed the association between predictors and outcomes while adjusting for confounders. RESULTS Late-preterm (34-36 weeks) birth was associated with increased odds of mortality compared with full-term (39-40 weeks) birth, while early-term (37-38 weeks) birth was not associated with increased mortality. Corrected GA at surgery of 34 to 37 weeks compared with 40 to 44 weeks was associated with increased mortality. When analyzing corrected GA at surgery as a continuous predictor of outcome, odds of survival improve as patients approach 39 weeks corrected GA. CONCLUSIONS Contrary to previous literature, we did not find an association between early-term birth and hospital mortality at PC4 hospitals. Our analysis of the relationship between corrected GA and mortality suggests that operating closer to full-term corrected GA may improve survival.
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Affiliation(s)
- Fabio Savorgnan
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Justin J Elhoff
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
| | - Danielle Guffey
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - David Axelrod
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Jason R Buckley
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Michael Gaies
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Nancy S Ghanayem
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Javier J Lasa
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Lara Shekerdemian
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - James S Tweddell
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - David K Werho
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Justin Yeh
- Department of Pediatrics, University of California-San Diego, San Diego, California
| | - Martina A Steurer
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pediatrics, University of California, San Francisco, California
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74
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Current Trends and Critical Care Considerations for the Management of Single Ventricle Neonates. CURRENT PEDIATRICS REPORTS 2020. [DOI: 10.1007/s40124-020-00227-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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75
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Factors That Contribute to Cost Differences Based on ICU of Admission in Neonates Undergoing Congenital Heart Surgery: A Novel Decomposition Analysis. Pediatr Crit Care Med 2020; 21:e842-e847. [PMID: 32769705 PMCID: PMC7968580 DOI: 10.1097/pcc.0000000000002507] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We leveraged decomposition analysis, commonly used in labor economics, to understand determinants of cost differences related to location of admission in children undergoing neonatal congenital heart surgery. DESIGN A retrospective cohort study. SETTING Pediatric Health Information Systems database. PATIENTS Neonates (<30 d old) undergoing their index congenital heart surgery between 2004 and 2013. MEASUREMENTS AND MAIN RESULTS A decomposition analysis with bootstrapping determined characteristic (explainable by differing covariate levels) and structural effects (if covariates are held constant) related to cost differences. Covariates included center volume, age at admission, prematurity, sex, race, genetic or major noncardiac abnormality, Risk Adjustment for Congenital Heart Surgery-1 score, payor, admission year, cardiac arrest, infection, and delayed sternal closure.Of 19,984 infants included (10,491 [52%] to cardiac ICU/PICU and 9,493 [48%] to neonatal ICU), admission to the neonatal ICU had overall higher average costs ($24,959 ± $3,260; p < 0.001) versus cardiac ICU/PICU admission. Characteristic effects accounted for higher costs in the neonatal ICU ($28,958 ± $2,044; p < 0.001). Differing levels of prematurity, genetic syndromes, hospital volume, age at admission, and infection contributed to higher neonatal ICU costs, with infection rate providing the most significant contribution ($13,581; p < 0.001). Aggregate structural effects were not associated with cost differences for those admitted to the neonatal ICU versus cardiac ICU/PICU (p = 0.1). Individually, prematurity and age at admission were associated with higher costs due to structural effects for infants admitted to the neonatal ICU versus cardiac ICU/PICU. CONCLUSIONS The difference in cost between neonatal ICU and cardiac ICU/PICU admissions is largely driven by differing prevalence of risk factors between these units. Infection rate was a modifiable factor that accounted for the largest difference in costs between admitting units.
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Alphonso N, Angelini A, Barron DJ, Bellsham-Revell H, Blom NA, Brown K, Davis D, Duncan D, Fedrigo M, Galletti L, Hehir D, Herberg U, Jacobs JP, Januszewska K, Karl TR, Malec E, Maruszewski B, Montgomerie J, Pizzaro C, Schranz D, Shillingford AJ, Simpson JM. Guidelines for the management of neonates and infants with hypoplastic left heart syndrome: The European Association for Cardio-Thoracic Surgery (EACTS) and the Association for European Paediatric and Congenital Cardiology (AEPC) Hypoplastic Left Heart Syndrome Guidelines Task Force. Eur J Cardiothorac Surg 2020; 58:416-499. [DOI: 10.1093/ejcts/ezaa188] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Nelson Alphonso
- Queensland Pediatric Cardiac Service, Queensland Children’s Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Annalisa Angelini
- Department of Cardiac, Thoracic Vascular Sciences and Public health, University of Padua Medical School, Padua, Italy
| | - David J Barron
- Department of Cardiovascular Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Nico A Blom
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Katherine Brown
- Paediatric Intensive Care, Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Deborah Davis
- Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA, USA
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
| | - Daniel Duncan
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
| | - Marny Fedrigo
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Lorenzo Galletti
- Unit of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - David Hehir
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ulrike Herberg
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | | | - Katarzyna Januszewska
- Division of Pediatric Cardiac Surgery, University Hospital Muenster, Westphalian-Wilhelm’s-University, Muenster, Germany
| | | | - Edward Malec
- Division of Pediatric Cardiac Surgery, University Hospital Muenster, Westphalian-Wilhelm’s-University, Muenster, Germany
| | - Bohdan Maruszewski
- Department for Pediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - James Montgomerie
- Department of Anesthesia, Birmingham Children’s Hospital, Birmingham, UK
| | - Christian Pizzaro
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dietmar Schranz
- Pediatric Heart Center, Justus-Liebig University, Giessen, Germany
| | - Amanda J Shillingford
- Division of Cardiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Namachivayam SP, Carlin JB, Millar J, Alexander J, Edmunds S, Ganeshalingham A, Lew J, Erickson S, Butt W, Schlapbach LJ, Ganu S, Festa M, Egan JR, Williams G, Young J. Gestational Age and Risk of Mortality in Term-Born Critically Ill Neonates Admitted to PICUs in Australia and New Zealand. Crit Care Med 2020; 48:e648-e656. [PMID: 32697505 DOI: 10.1097/ccm.0000000000004409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Gestational age at birth is declining, probably because more deliveries are being induced. Gestational age is an important modifiable risk factor for neonatal mortality and morbidity. We aimed to investigate the association between gestational age and mortality in hospital for term-born neonates (≥ 37 wk') admitted to PICUs in Australia and New Zealand. DESIGN Observational multicenter cohort study. SETTING PICUs in Australia and New Zealand. PATIENTS Term-born neonates (≥ 37 wk) admitted to PICUs. INTERVENTIONS None MEASUREMENTS AND MAIN RESULTS:: We studied 5,073 infants born with a gestational age greater than or equal to 37 weeks and were less than 28 days old when admitted to a PICU in Australia or New Zealand between 2007 and 2016. The association between gestational age and mortality was estimated using a multivariable logistic regression model, adjusting for age, sex, indigenous status, Pediatric Index of Mortality version 2, and site. The median gestational age was 39.1 weeks (interquartile range, 38.2-40 wk) and mortality in hospital was 6.6%. Risk of mortality declined log-linearly with gestational age. The adjusted analysis showed a 20% (95% CI, 11-28%) relative reduction in mortality for each extra week of gestation beyond 37 weeks. The effect of gestation was stronger among those who received extracorporeal life support: each extra week of gestation was associated with a 44% (95% CI, 25-57%) relative reduction in mortality. Longer gestation was also associated with reduced length of stay in hospital: each week increase in gestation, the average length of stay decreased by 4% (95% CI, 2-6%). CONCLUSIONS Among neonates born at "term" who are admitted to a PICU, increasing gestational age at birth is associated with a substantial reduction in the risk of dying in hospital. The maturational influence on outcome was more strongly noted in the sickest neonates, such as those requiring extracorporeal life support. This information is important in view of the increasing proportion of planned births in both high- and low-/middle-income countries.
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Affiliation(s)
- Siva P Namachivayam
- Pediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Registry, Centre for Outcomes and Resource Evaluation, Australian and New Zealand Intensive Care Society, Camberwell, VIC, Australia
- Pediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand
- Pediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, QLD, Australia
- Pediatric Critical Care Research Group, Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
- Pediatric Intensive Care Unit and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- Pediatric Intensive Care Unit, Women's and Children's Hospital, Adelaide, SA, Australia
- Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia
- Pediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Pediatric Intensive Care Unit, The Sydney Children's Hospital, Sydney, NSW, Australia
| | - John B Carlin
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Johnny Millar
- Australian and New Zealand Intensive Care Registry, Centre for Outcomes and Resource Evaluation, Australian and New Zealand Intensive Care Society, Camberwell, VIC, Australia
| | - Janet Alexander
- Australian and New Zealand Intensive Care Registry, Centre for Outcomes and Resource Evaluation, Australian and New Zealand Intensive Care Society, Camberwell, VIC, Australia
| | - Sarah Edmunds
- Pediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand
| | | | - Jamie Lew
- Pediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia
| | - Simon Erickson
- Pediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia
| | - Warwick Butt
- Pediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Registry, Centre for Outcomes and Resource Evaluation, Australian and New Zealand Intensive Care Society, Camberwell, VIC, Australia
- Pediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand
- Pediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, QLD, Australia
- Pediatric Critical Care Research Group, Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
- Pediatric Intensive Care Unit and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- Pediatric Intensive Care Unit, Women's and Children's Hospital, Adelaide, SA, Australia
- Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia
- Pediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Pediatric Intensive Care Unit, The Sydney Children's Hospital, Sydney, NSW, Australia
| | - Luregn J Schlapbach
- Pediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Registry, Centre for Outcomes and Resource Evaluation, Australian and New Zealand Intensive Care Society, Camberwell, VIC, Australia
- Pediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand
- Pediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, QLD, Australia
- Pediatric Critical Care Research Group, Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
- Pediatric Intensive Care Unit and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- Pediatric Intensive Care Unit, Women's and Children's Hospital, Adelaide, SA, Australia
- Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia
- Pediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Pediatric Intensive Care Unit, The Sydney Children's Hospital, Sydney, NSW, Australia
| | - Subodh Ganu
- Pediatric Intensive Care Unit, Women's and Children's Hospital, Adelaide, SA, Australia
- Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia
| | - Marino Festa
- Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia
| | - Jonathan R Egan
- Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia
| | - Gary Williams
- Pediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Janelle Young
- Pediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
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Castellanos DA, Lopez KN, Salemi JL, Shamshirsaz AA, Wang Y, Morris SA. Trends in Preterm Delivery among Singleton Gestations with Critical Congenital Heart Disease. J Pediatr 2020; 222:28-34.e4. [PMID: 32586534 PMCID: PMC7377282 DOI: 10.1016/j.jpeds.2020.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/01/2020] [Accepted: 03/02/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To examine state-wide population trends in preterm delivery of children with critical congenital heart disease (CHD) over an 18-year period. We hypothesized that, coincident with early advancements in prenatal diagnosis, preterm delivery initially increased compared with the general population, and more recently has decreased. STUDY DESIGN Data from the Texas Public Use Data File 1999-2016 was used to evaluate annual percent preterm delivery (<37 weeks) in critical CHD (diagnoses requiring intervention at <1 year of age). We first evaluated for pattern change over time using joinpoint segmented regression. Trends in preterm delivery were then compared with all Texas livebirths. We then compared trends examining sociodemographic covariates including race/ethnicity, sex, and neighborhood poverty levels. RESULTS Of 7146 births with critical CHD, 1339 (18.7%) were delivered preterm. The rate of preterm birth increased from 1999 to 2004 (a mean increase of 1.69% per year) then decreased between 2005 and 2016 (a mean decrease of -0.41% per year). This represented a faster increase and then a similar decrease to that noted in the general population. Although the greatest proportion of preterm births occurred in newborns of Hispanic ethnicity and non-Hispanic black race, newborns with higher neighborhood poverty level had the most rapidly increasing rate of preterm delivery in the first era, and only a plateau rather than decrease in the latter era. CONCLUSIONS Rates of preterm birth for newborns with critical CHD in Texas first were increasing rapidly, then have been decreasing since 2005.
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Affiliation(s)
- Daniel A. Castellanos
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas
| | - Keila N. Lopez
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas
| | - Jason L. Salemi
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Alireza A. Shamshirsaz
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas, USA
| | - Yunfei Wang
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas
| | - Shaine A. Morris
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas
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79
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Abstract
OBJECTIVE To evaluate delivery management and outcomes in fetuses prenatally diagnosed with CHD. STUDY DESIGN A retrospective cohort study was conducted on 6194 fetuses (born between 2013 and 2016), comparing prenatally diagnosed with CHD (170) to those with non-cardiac (234) and no anomalies (5790). Primary outcomes included the incidence of preterm delivery and mode of delivery. RESULTS Gestational age at delivery was significantly lower between the CHD and non-anomalous cohorts (38.6 and 39.1 weeks, respectively). Neonates with CHD had a significantly lower birth weights (p < 0.001). There was an approximately 1.5-fold increase in the rate of primary cesarean sections associated with prenatally diagnosed CHD with an odds ratio of 1.49 (95% CI 1.06-2.10). CONCLUSIONS Our study provides additional evidence that the prenatal diagnosis of CHD is associated with a lower birth weight, preterm delivery, and with an increased risk of delivery by primary cesarean section.
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80
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4802] [Impact Index Per Article: 1200.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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81
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Smith BJ, Flyer JN, Edwards EM, Soll RF, Horbar JD, Yeager SB. Outcomes for Ectopia Cordis. J Pediatr 2020; 216:67-72. [PMID: 31668886 DOI: 10.1016/j.jpeds.2019.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/15/2019] [Accepted: 09/10/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To utilize a large multicenter neonatal cohort to describe survival and clinical outcomes of very low birth weight (VLBW) or preterm infants with ectopia cordis. STUDY DESIGN Data were prospectively collected on 2 211 262 infants (born 2000-2017) from 845 US centers. Both VLBW (401-1500 g or 22-29 weeks of gestation) and non-VLBW (>1500 g and >29 weeks) infants had diagnoses or anatomic descriptors consistent with ectopia cordis and/or pentalogy of Cantrell. The primary outcome was neonatal survival, defined as hospital discharge or initial length of stay of ≥12 months. RESULTS In total, 180 infants had ectopia cordis, 135 (76%) with findings of pentalogy of Cantrell. VLBW infants comprised 52% of the population. VLBW mortality was 96% with 79% dying within 12 hours, compared with 59% and 36%, respectively, for non-VLBW. One-third of VLBW infants received life support compared with 65% of non-VLBW. Surgery was reported for 34% of VLBW and 68% of non-VLBW infants. Congenital heart disease was reported in 8% of VLBW and 36% of non-VLBW, with conotruncal abnormalities most common. Survival exceeded 50% for infants >2500 g and >37 weeks of gestation. CONCLUSIONS Survival of VLBW infants with ectopia cordis was poor and substantially worse compared with non-VLBW, with notable discrepancies in resuscitative efforts and surgical interventions. Although gestational age and weight strongly influence current survival, more detailed information regarding the severity of cardiac and noncardiac abnormalities is required to fully determine prognosis and inform counseling.
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Affiliation(s)
| | - Jonathan N Flyer
- Department of Pediatrics, University of Vermont, Burlington, VT; Division of Pediatric Cardiology, University of Vermont, Burlington, VT
| | - Erika M Edwards
- Department of Pediatrics, University of Vermont, Burlington, VT; Department of Mathematics and Statistics, University of Vermont, Burlington, VT; Vermont Oxford Network, Burlington, VT
| | - Roger F Soll
- Department of Pediatrics, University of Vermont, Burlington, VT; Vermont Oxford Network, Burlington, VT; Division of Neonatology, University of Vermont, Burlington, VT
| | - Jeffrey D Horbar
- Department of Pediatrics, University of Vermont, Burlington, VT; Vermont Oxford Network, Burlington, VT; Division of Neonatology, University of Vermont, Burlington, VT
| | - Scott B Yeager
- Department of Pediatrics, University of Vermont, Burlington, VT; Division of Pediatric Cardiology, University of Vermont, Burlington, VT.
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82
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5295] [Impact Index Per Article: 1059.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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83
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Needs and stressors of parents of term and near-term infants in the NICU: A systematic review with best practice guidelines. Early Hum Dev 2019; 139:104839. [PMID: 31439386 DOI: 10.1016/j.earlhumdev.2019.104839] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Having a sick infant in the NICU can be quite stressful and overwhelming to parents. They require support and may have varied needs. A systematic review of qualitative and quantitative studies from 5 electronic databases (Ovid Medline, EMBASE, PsycINFO, CINAHL and Sociological Abstracts), covering January 2001 - March 2016 identified the needs and stressors of parents of term or near-term Infants in the NICU. Six articles addressed the needs and 14 identified the stressors of parents. Parents' most important need was for accurate and honest information. Needs focused around sensitive infant care and involvement in decision-making. The greatest stressor for parents was alteration to the parental role, followed by infant appearance. Fathers and parents of infants undergoing surgery are an under-researched population. Based on the evidence, enhancing staff-parent communication would better meet parental needs and reduce stressors. Our key recommendations highlight the need for family-centred and individualised care practices in the NICU.
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84
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Steurer MA, Peyvandi S, Baer RJ, Oltman SP, Chambers CD, Norton ME, Ryckman KK, Moon-Grady AJ, Keller RL, Shiboski SC, Jelliffe-Pawlowski LL. Impaired Fetal Environment and Gestational Age: What Is Driving Mortality in Neonates With Critical Congenital Heart Disease? J Am Heart Assoc 2019; 8:e013194. [PMID: 31726960 PMCID: PMC6915289 DOI: 10.1161/jaha.119.013194] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Infants with critical congenital heart disease (CCHD) are more likely to be small for gestational age (SGA) or born to mothers with maternal placental syndrome. The objective of this study was to investigate the relationship between maternal placental syndrome, SGA, and gestational age (GA) on 1‐year mortality in infants with CCHD. Methods and Results In a population‐based administrative database of all live‐born infants in California (2007–2012) we identified all infants with CCHD without chromosomal anomalies. Our primary predictor was an impaired fetal environment (IFE), defined as presence of maternal placental syndrome or SGA. We calculated hazard ratios to quantify the association between different components of IFE and 1‐year mortality and conducted a causal mediation analysis to assess GA at birth as a mediator. We identified 6863 infants with CCHD. IFE was present in 25.1%. Infants with IFE were more likely to die than infants without IFE (16.6% versus 11.1%; hazard ratios 1.55, 95% CI 1.34–1.78). Only SGA (hazard ratios 1.76, 95% CI 1.50–2.05) and placental abruption (hazard ratios 1.70, 95% CI 1.17–2.48) were significantly associated with mortality; preeclampsia and gestational hypertension had no significant association with mortality. The mediation analysis showed that 32.8% (95% CI 24.9–47.0%) of the relationship between IFE and mortality is mediated through GA. Conclusions IFE is a significant contributor to outcomes in the CCHD population. SGA and placental abruption are the main drivers of postnatal mortality while other maternal placental syndrome components had much less of an impact. Only one third of the effect between IFE and mortality is mediated through GA.
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Affiliation(s)
- Martina A Steurer
- Department of Pediatrics University of California San Francisco San Francisco CA.,Department of Epidemiology and Biostatistics University of California San Francisco San Francisco CA
| | - Shabnam Peyvandi
- Department of Pediatrics University of California San Francisco San Francisco CA.,Department of Epidemiology and Biostatistics University of California San Francisco San Francisco CA
| | - Rebecca J Baer
- Department of Pediatrics University of California San Diego La Jolla CA.,Department of Obstetrics, Gynecology, and Reproductive Sciences University of California San Francisco San Francisco CA
| | - Scott P Oltman
- Department of Epidemiology and Biostatistics University of California San Francisco San Francisco CA
| | | | - Mary E Norton
- Department of Obstetrics, Gynecology, and Reproductive Sciences University of California San Francisco San Francisco CA
| | - Kelli K Ryckman
- Department of Epidemiology College of Public Health University of Iowa Iowa City IA
| | - Anita J Moon-Grady
- Department of Pediatrics University of California San Francisco San Francisco CA
| | - Roberta L Keller
- Department of Pediatrics University of California San Francisco San Francisco CA
| | - Stephen C Shiboski
- Department of Epidemiology and Biostatistics University of California San Francisco San Francisco CA
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85
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Namachivayam SP. Invited Commentary. Ann Thorac Surg 2019; 109:1267. [PMID: 31678475 DOI: 10.1016/j.athoracsur.2019.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/22/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Siva P Namachivayam
- Cardiac Intensive Care Unit, The Royal Children's Hospital Melbourne, Murdoch Children's Research Institute, Flemington Rd, Melbourne, Victoria 3052, Australia.
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86
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Impact of Gestational Age on Surgical Outcomes in Patients With Functionally Single Ventricle. Ann Thorac Surg 2019; 109:1260-1266. [PMID: 31580862 DOI: 10.1016/j.athoracsur.2019.08.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 06/26/2019] [Accepted: 08/19/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Younger gestational age (GA) is known to be associated with worse outcomes after congenital cardiac surgery. We sought to determine the impact of GA on surgical outcomes of single-ventricle palliation. METHODS Among the 284 patients with functionally single ventricle who were born between January 2005 and December 2014, 50 neonates were born prematurely (GA < 37 weeks) and 113 neonates in the early term period (37 weeks ≤ GA < 39 weeks). Initial palliation was required in 251 patients, whereas 33 patients received primary bidirectional cavopulmonary anastomosis (BCPA). RESULTS BCPA and the completion Fontan operation were performed in 200 and 169 patients, respectively. Overall survival at 5 years were 62.5% ± 2.9%. On Cox regression younger GA (hazard ratio, 1.14 per 1-week decrease; P = .007) was identified as a risk factor for increased interstage mortality (ISM) between initial palliation and BCPA. On subgroup analysis of the preterm or early-term patients with initial palliation (n = 145), younger postmenstrual age at initial palliation was associated with increased ISM before BCPA (hazard ratio, 1.18; P = .005). After BCPA, however, younger GA did not increase the risk of ISM between BCPA and the Fontan operation (P = .47). CONCLUSIONS Younger GA is a risk factor for ISM between initial palliation and BCPA. Deferral of initial palliation may be beneficial to decrease the risk of ISM in patients who were born at preterm or early term. Adverse effects of younger GA on survival disappeared once BCPA was performed.
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87
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Howell HB, Zaccario M, Kazmi SH, Desai P, Sklamberg FE, Mally P. Neurodevelopmental outcomes of children with congenital heart disease: A review. Curr Probl Pediatr Adolesc Health Care 2019; 49:100685. [PMID: 31708366 DOI: 10.1016/j.cppeds.2019.100685] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Congenital heart defects are the most common birth anomaly affecting approximately 1% of births. With improved survival in this population, there is enhanced ability to assess long-term morbidities including neurodevelopment. There is a wide range of congenital heart defects, from those with minimal physiologic consequence that do not require medical or surgical intervention, to complex structural anomalies requiring highly specialized medical management and intricate surgical repair or palliation. The impact of congenital heart disease on neurodevelopment is multifactorial. Susceptibility for adverse neurodevelopment increases with advancing severity of the defect with initial risk factors originating during gestation. Complex structural heart anomalies may pre-dispose the fetus to abnormal circulatory patterns in utero that ultimately impact delivery of oxygen rich blood to the fetal brain. Thus, the brain of a neonate born with complex congenital heart disease may be particularly vulnerable from the outset. That vulnerability is compounded during the newborn period and through childhood, as this population endures a myriad of medical and surgical interventions. For each individual patient, these factors are likely cumulative and synergistic with progression from fetal life through childhood. This review discusses the spectrum of risk factors that may impact neurodevelopment in children with congenital heart disease, describes current recommendations and practices for neurodevelopmental follow-up of children with congenital heart disease and reviews important neurodevelopmental trends in this high risk population.
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Affiliation(s)
- Heather B Howell
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA.
| | - Michele Zaccario
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA; Pace University, Department of Psychology, 41 Park Row, New York, NY 10038 USA
| | - Sadaf H Kazmi
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA
| | - Purnahamsi Desai
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA
| | - Felice E Sklamberg
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA
| | - Pradeep Mally
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA
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88
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Gaynor JW, Parry S, Moldenhauer JS, Simmons RA, Rychik J, Ittenbach RF, Russell WW, Zullo E, Ward JL, Nicolson SC, Spray TL, Johnson MP. The impact of the maternal-foetal environment on outcomes of surgery for congenital heart disease in neonates. Eur J Cardiothorac Surg 2019; 54:348-353. [PMID: 29447332 DOI: 10.1093/ejcts/ezy015] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 01/04/2018] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Pregnancies with congenital heart disease in the foetus have an increased prevalence of pre-eclampsia, small for gestational age and preterm birth, which are evidence of an impaired maternal-foetal environment (MFE). METHODS The impact of an impaired MFE, defined as pre-eclampsia, small for gestational age or preterm birth, on outcomes after cardiac surgery was evaluated in neonates (n = 135) enrolled in a study evaluating exposure to environmental toxicants and neuro-developmental outcomes. RESULTS The most common diagnoses were transposition of the great arteries (n = 47) and hypoplastic left heart syndrome (n = 43). Impaired MFE was present in 28 of 135 (21%) subjects, with small for gestational age present in 17 (61%) patients. The presence of an impaired MFE was similar for all diagnoses, except transposition of the great arteries (P < 0.006). Postoperative length of stay was shorter for subjects without an impaired MFE (14 vs 38 days, P < 0.001). Hospital mortality was not significantly different with or without impaired MFE (11.7% vs 2.8%, P = 0.104). However, for the entire cohort, survival at 36 months was greater for those without an impaired MFE (96% vs 68%, P = 0.001). For patients with hypoplastic left heart syndrome, survival was also greater for those without an impaired MFE (90% vs 43%, P = 0.007). CONCLUSIONS An impaired MFE is common in pregnancies in which the foetus has congenital heart disease. After cardiac surgery in neonates, the presence of an impaired MFE was associated with lower survival at 36 months of age for the entire cohort and for the subgroup with hypoplastic left heart syndrome.
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Affiliation(s)
- James William Gaynor
- Division of Cardiac Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Samuel Parry
- Division of Maternal Fetal Medicine, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Julie S Moldenhauer
- Center for Fetal Diagnosis and Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rebecca A Simmons
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jack Rychik
- Division of Pediatric Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Richard F Ittenbach
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - William W Russell
- Division of Cardiac Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erin Zullo
- Division of Cardiac Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - John Laurenson Ward
- Division of Cardiac Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan C Nicolson
- Division of Pediatric Cardiac Anesthesiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Thomas L Spray
- Division of Cardiac Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mark P Johnson
- Center for Fetal Diagnosis and Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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89
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Fontes K, Rohlicek CV, Saint-Martin C, Gilbert G, Easson K, Majnemer A, Marelli A, Chakravarty MM, Brossard-Racine M. Hippocampal alterations and functional correlates in adolescents and young adults with congenital heart disease. Hum Brain Mapp 2019; 40:3548-3560. [PMID: 31070841 DOI: 10.1002/hbm.24615] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/30/2019] [Accepted: 04/24/2019] [Indexed: 01/18/2023] Open
Abstract
There is a high prevalence of neurodevelopmental impairments in individuals living with congenital heart disease (CHD) and the neural correlates of these impairments are not yet fully understood. Recent studies have shown that hippocampal volume and shape differences may provide unique biomarkers for neurodevelopmental disorders. The hippocampus is vulnerable to early life injury, especially in populations at risk for hypoxemia or hemodynamic instability such as in neonates with CHD. We compared hippocampal gray and white matter volume and morphometry between youth born with CHD (n = 50) aged 16-24 years and healthy peers (n = 48). We also explored whether hippocampal gray and white matter volume and morphometry are associated with executive function and self-regulation deficits. To do so, participants underwent 3T brain magnetic resonance imaging and completed the self-reported Behavior Rating Inventory of Executive Function-Adult version. We found that youth with CHD had smaller hippocampal volumes (all statistics corrected for false discovery rate; q < 0.05) as compared to controls. We also observed significant smaller surface area bilaterally and inward displacement on the left hippocampus predominantly on the ventral side (q < 0.10) in the CHD group that were not present in the controls. Left CA1 and CA2/3 were negatively associated with working memory (p < .05). Here, we report, for the first-time, hippocampal morphometric alterations in youth born with CHD when compared to healthy peers, as well as, structure-function relationships between hippocampal volumes and executive function. These differences may reflect long lasting alterations in brain development specific to individual with CHD.
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Affiliation(s)
- Kimberly Fontes
- Advances in Brain and Child Health Development Research Laboratory, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Charles V Rohlicek
- Department of Pediatrics, Division of Cardiology, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Christine Saint-Martin
- Department of Medical Imaging, Division of Pediatric Radiology, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Kaitlyn Easson
- Advances in Brain and Child Health Development Research Laboratory, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Annette Majnemer
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence, McGill University, Montreal, Quebec, Canada
| | - M Mallar Chakravarty
- Computational Brain Anatomy Laboratory, Cerebral Imaging Centre - Douglas Mental Health University Institute, Verdun, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Department of Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Marie Brossard-Racine
- Advances in Brain and Child Health Development Research Laboratory, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Department of Pediatrics, Division of Neonatology, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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90
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Miller TA, Ghanayem NS, Newburger JW, McCrindle BW, Hu C, DeWitt AG, Cnota JF, Tractenberg FL, Pemberton VL, Wolf MJ, Votava-Smith JK, Fifer CG, Lambert LM, Shah A, Graham EM, Pizarro C, Jacobs JP, Miller SG, Minich LL. Gestational Age, Birth Weight, and Outcomes Six Years After the Norwood Procedure. Pediatrics 2019; 143:peds.2018-2577. [PMID: 30979811 PMCID: PMC6564065 DOI: 10.1542/peds.2018-2577] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Preterm delivery and low birth weight (LBW) are generally associated with worse outcomes in hypoplastic left heart syndrome (HLHS), but an individual preterm or small neonate may do well. We sought to explore the interactions between gestational age, birth weight, and birth weight for gestational age with intermediate outcomes in HLHS. METHODS We analyzed survival, growth, neurodevelopment, length of stay, and complications to age 6 years in subjects with HLHS from the Single Ventricle Reconstruction trial. Univariate and multivariable survival and regression analyses examined the effects and interactions of LBW (<2500 g), weight for gestational age, and gestational age category. RESULTS Early-term delivery (n = 234) was more common than term (n = 219) delivery. Small for gestational age (SGA) was present in 41% of subjects, but only 14% had LBW. Preterm, compared with term, delivery was associated with an increased risk of death or transplant at age 6 years (all: hazard ratio = 2.58, confidence interval = 1.43-4.67; Norwood survivors: hazard ratio = 1.96, confidence interval = 1.10-3.49) independent of LBW and weight for gestational age. Preterm delivery, early-term delivery, LBW, and SGA were each associated with lower weight at 6 years. Neurodevelopmental outcomes were worst in the LBW cohort. CONCLUSIONS Preterm delivery in HLHS was associated with worse survival, even beyond Norwood hospitalization. LBW, SGA, and early-term delivery were associated with worse growth but not survival. LBW was associated with worse neurodevelopment, despite similar length of stay and complications. These data suggest that preterm birth and LBW (although often concomitant) are not equivalent, impacting clinical outcomes through mechanisms independent of perioperative course complexity.
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Affiliation(s)
- Thomas A. Miller
- Department of Pediatrics, The University of Utah, Salt Lake City, Utah
| | - Nancy S. Ghanayem
- Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas
| | - Jane W. Newburger
- Department of Cardiology, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Brian W. McCrindle
- Department of Pediatrics, University of Toronto and Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada
| | - Chenwei Hu
- New England Research Institute, Watertown, Massachusetts
| | - Aaron G. DeWitt
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - James F. Cnota
- Heart Institute, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | | | - Victoria L. Pemberton
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Michael J. Wolf
- Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia
| | - Jodie K. Votava-Smith
- Department of Pediatrics, Children’s Hospital of Los Angeles, Los Angeles, California
| | - Carlen G. Fifer
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Linda M. Lambert
- Department of Pediatrics, The University of Utah, Salt Lake City, Utah
| | - Amee Shah
- Department of Pediatrics, Columbia University, New York, New York
| | - Eric M. Graham
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Christian Pizarro
- Departments of Surgery and Pediatrics, Thomas Jefferson University, Wilmington, Delaware
| | - Jeffrey P. Jacobs
- The Congenital Heart Institute of Florida, St. Petersburg, Florida; and
| | - Stephen G. Miller
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - L. LuAnn Minich
- Department of Pediatrics, The University of Utah, Salt Lake City, Utah
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91
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Neonatal and Paediatric Heart and Renal Outcomes Network: design of a multi-centre retrospective cohort study. Cardiol Young 2019; 29:511-518. [PMID: 31107196 DOI: 10.1017/s1047951119000210] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cardiac surgery-associated acute kidney injury is common. In order to improve our understanding of acute kidney injury, we formed the multi-centre Neonatal and Pediatric Heart and Renal Outcomes Network. Our main goals are to describe neonatal kidney injury epidemiology, evaluate variability in diagnosis and management, identify risk factors, investigate the impact of fluid overload, and explore associations with outcomes. METHODS The Neonatal and Pediatric Heart and Renal Outcomes Network collaborative includes representatives from paediatric cardiac critical care, cardiology, nephrology, and cardiac surgery. The collaborative sites and infrastructure are part of the Pediatric Cardiac Critical Care Consortium. An acute kidney injury module was developed and merged into the existing infrastructure. A total of twenty-two participating centres provided data on 100-150 consecutive neonates who underwent cardiac surgery within the first 30 post-natal days. Additional acute kidney injury variables were abstracted by chart review and merged with the corresponding record in the quality improvement database. Exclusion criteria included >1 operation in the 7-day study period, pre-operative renal replacement therapy, pre-operative serum creatinine >1.5 mg/dl, and need for extracorporeal support in the operating room or within 24 hours after the index operation. RESULTS A total of 2240 neonatal patients were enrolled across 22 centres. The incidence of acute kidney injury was 54% (stage 1 = 31%, stage 2 = 13%, and stage 3 = 9%). CONCLUSIONS Neonatal and Pediatric Heart and Renal Outcomes Network represents the largest multi-centre study of neonatal kidney injury. This new network will enhance our understanding of kidney injury and its complications.
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92
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Rocha LA, Froio SC, Silva CC, Figueira SDAN, Guilhen JCS, Guinsburg R, Araujo Júnior E. Risk Factors for Mortality in Children with Congenital Heart Disease Delivered at a Brazilian Tertiary Center. Braz J Cardiovasc Surg 2019; 33:603-607. [PMID: 30652750 PMCID: PMC6326451 DOI: 10.21470/1678-9741-2018-0174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/25/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aims to investigate the incidence of postnatal diagnosis of congenital heart disease (CHD) and the predictive factors for hospital mortality. METHODS This retrospective cohort study was conducted at a Brazilian tertiary center, and data were collected from medical records with inclusion criteria defined as any newborn with CHD diagnosed in the postnatal period delivered between 2015 and 2017. Univariate and multivariate analyses were performed to determine the potential risk factors for mortality. RESULTS During the 3-year period, 119 (5.3%) children of the 2215 children delivered at our institution were diagnosed with CHD. We considered birth weight (P=0.005), 1st min Apgar score (P=0.001), and CHD complexity (P=0.013) as independent risk factors for in-hospital mortality. The most common CHD was ventricular septal defect. Indeed, 60.5% cases were considered as "complex" or "significant" CHDs. Heart surgeries were performed on 38.9% children, 15 of whom had "complex" or "significant" CHD. A mortality rate of 42% was observed in this cohort, with 28% occurring within the initial 24 h after delivery and 38% occurring in patients admitted for heart surgery. CONCLUSION The postnatal incidence of CHD at our service was 5.3%. Low 1st min Apgar score, low birth weight, and CHD complexity were the independent factors that affected the hospital outcome.
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Affiliation(s)
- Luciane Alves Rocha
- Discipline of Fetal Medicine, Department of Obstetrics, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Sthefane Catib Froio
- Discipline of Fetal Medicine, Department of Obstetrics, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Célia Camelo Silva
- Discipline of Cardiology, Department of Medical Clinic, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Simone de Araujo Negreiros Figueira
- Discipline of Neonatology, Department of Pediatrics, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - José Cícero Stocco Guilhen
- Discipline of Cardiovascular Surgery, Department of Surgery, Escola Paulista de Medicina da Universidade Federal de Sao Paulo (EPM-UNIFESP), Sao Paulo, SP, Brazil
| | - Ruth Guinsburg
- Discipline of Neonatology, Department of Pediatrics, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Edward Araujo Júnior
- Discipline of Fetal Medicine, Department of Obstetrics, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
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93
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Birth Location of Infants with Critical Congenital Heart Disease in California. Pediatr Cardiol 2019; 40:310-318. [PMID: 30415381 DOI: 10.1007/s00246-018-2019-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/01/2018] [Indexed: 10/27/2022]
Abstract
The American Academy of Pediatrics classifies neonatal intensive care units (NICUs) from level I to IV based on the acuity of care each unit can provide. Birth in a higher level center is associated with lower morbidity and mortality in high-risk populations. Congenital heart disease accounts for 25-50% of infant mortality related to birth defects in the U.S., but recent data are lacking on where infants with critical congenital heart disease (CCHD) are born. We used a linked dataset from the Office of Statewide Health Planning and Development to access ICD-9 diagnosis codes for all infants born in California from 2008 to 2012. We compared infants with CCHD to the general population, identified where infants with CCHD were born based on NICU level of care, and predicted level IV birth among infants with CCHD using logistic regression techniques. From 2008 to 2012, 6325 infants with CCHD were born in California, with 23.7% of infants with CCHD born at a level IV NICU compared to 8.4% of the general population. Level IV birth for infants with CCHD was associated with lower gestational age, higher maternal age and education, the presence of other congenital anomalies, and the diagnosis of a single ventricle lesion. More infants with CCHD are born in a level IV NICU compared to the general population. Future studies are needed to determine if birth in a lower level of care center impacts outcomes for infants with CCHD.
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94
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Brugmans M, Serrero A, Cox M, Svanidze O, Schoen FJ. Morphology and mechanisms of a novel absorbable polymeric conduit in the pulmonary circulation of sheep. Cardiovasc Pathol 2019; 38:31-38. [DOI: 10.1016/j.carpath.2018.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 12/23/2022] Open
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Peyvandi S, Donofrio MT. Circulatory Changes and Cerebral Blood Flow and Oxygenation During Transition in Newborns With Congenital Heart Disease. Semin Pediatr Neurol 2018; 28:38-47. [PMID: 30522727 DOI: 10.1016/j.spen.2018.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This review aims to describe how the complex events of cardiovascular transition may affect the brain of infants with congenital heart disease (CHD). In particular, we describe the vulnerabilities of the neonatal brain in the transitional period during and immediately after delivery and propose management strategies that can potentially influence neurodevelopmental outcomes in this patient population. Delayed brain development has been identified in the third trimester fetus with certain forms of CHD. Neonates with critical CHD are at risk for brain injury even before their neonatal operation. The transitional period from fetal to neonatal life is marked with hemodynamic changes that can affect cerebral blood flow and oxygenation and may exacerbate injury and influence outcome. We propose specific perinatal management strategies tailored to maternal-fetal pairs aimed at optimizing hemodynamic stability, especially cerebral blood flow and oxygenation, to maximize the neurodevelopmental potential of infants with CHD.
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Affiliation(s)
- Shabnam Peyvandi
- Division of Pediatric Cardiology, University of California San Francisco, Pediatric Heart Center, Benioff Children's Hospital, San Francisco, CA
| | - Mary T Donofrio
- Division of Cardiology, George Washington University, Children's National Health System, Washington, DC.
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96
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Abstract
The care of children with hypoplastic left heart syndrome is constantly evolving. Prenatal diagnosis of hypoplastic left heart syndrome will aid in counselling of parents, and selected fetuses may be candidates for in utero intervention. Following birth, palliation can be undertaken through staged operations: Norwood (or hybrid) in the 1st week of life, superior cavopulmonary connection at 4-6 months of life, and finally total cavopulmonary connection (Fontan) at 2-4 years of age. Children with hypoplastic left heart syndrome are at risk of circulatory failure their entire life, and selected patients may undergo heart transplantation. In this review article, we summarise recent advances in the critical care management of patients with hypoplastic left heart syndrome as were discussed in a focused session at the 12th International Conference of the Paediatric Cardiac Intensive Care Society held on 9 December, 2016, in Miami Beach, Florida.
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97
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Barker PC, Tatum GH, Campbell MJ, Camitta MGW, Milazzo AS, Hornik CP, French A, Miller SG. Improving maternal-infant bonding after prenatal diagnosis of CHD. Cardiol Young 2018; 28:1306-1315. [PMID: 30079851 PMCID: PMC6197928 DOI: 10.1017/s104795111800121x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Infants with prenatally diagnosed CHD are at high risk for adverse outcomes owing to multiple physiologic and psychosocial factors. Lack of immediate physical postnatal contact because of rapid initiation of medical therapy impairs maternal-infant bonding. On the basis of expected physiology, maternal-infant bonding may be safe for select cardiac diagnoses. METHODS This is a single-centre study to assess safety of maternal-infant bonding in prenatal CHD. RESULTS In total, 157 fetuses with prenatally diagnosed CHD were reviewed. On the basis of cardiac diagnosis, 91 fetuses (58%) were prenatally approved for bonding and successfully bonded, 38 fetuses (24%) were prenatally approved but deemed not suitable for bonding at delivery, and 28 (18%) were not prenatally approved to bond. There were no complications attributable to bonding. Those who successfully bonded were larger in weight (3.26 versus 2.6 kg, p<0.001) and at later gestation (39 versus 38 weeks, p<0.001). Those unsuccessful at bonding were more likely to have been delivered via Caesarean section (74 versus 49%, p=0.011) and have additional non-cardiac diagnoses (53 versus 29%, p=0.014). There was no significant difference regarding the need for cardiac intervention before hospital discharge. Infants who bonded had shorter hospital (7 versus 26 days, p=0.02) and ICU lengths of stay (5 versus 23 days, p=0.002) and higher survival (98 versus 76%, p<0.001). CONCLUSION Fetal echocardiography combined with a structured bonding programme can permit mothers and infants with select types of CHD to successfully bond before ICU admission and intervention.
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Affiliation(s)
- Piers C.A. Barker
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, USA
| | - Gregory H. Tatum
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, USA
| | - Michael J. Campbell
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, USA
| | - Michael GW Camitta
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, USA
| | - Angelo S. Milazzo
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, USA
| | | | - Amanda French
- Advanced Practice Nursing, Duke University Medical Center, Durham, USA
| | - Stephen G. Miller
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, USA
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Multicenter Validation of the Vasoactive-Ventilation-Renal Score as a Predictor of Prolonged Mechanical Ventilation After Neonatal Cardiac Surgery. Pediatr Crit Care Med 2018; 19:1015-1023. [PMID: 30095748 DOI: 10.1097/pcc.0000000000001694] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We sought to validate the Vasoactive-Ventilation-Renal score, a novel disease severity index, as a predictor of outcome in a multicenter cohort of neonates who underwent cardiac surgery. DESIGN Retrospective chart review. SETTING Seven tertiary-care referral centers. PATIENTS Neonates defined as age less than or equal to 30 days at the time of cardiac surgery. INTERVENTIONS Ventilation index, Vasoactive-Inotrope Score, serum lactate, and Vasoactive-Ventilation-Renal score were recorded for three postoperative time points: ICU admission, 6 hours, and 12 hours. Peak values, defined as the highest of the three measurements, were also noted. Vasoactive-Ventilation-Renal was calculated as follows: ventilation index + Vasoactive-Inotrope Score + Δ creatinine (change in creatinine from baseline × 10). Primary outcome was prolonged duration of mechanical ventilation, defined as greater than 96 hours. Receiver operative characteristic curves were generated, and abilities of variables to correctly classify prolonged duration of mechanical ventilation were compared using area under the curve values. Multivariable logistic regression modeling was also performed. MEASUREMENTS AND MAIN RESULTS We reviewed 275 neonates. Median age at surgery was 7 days (25th-75th percentile, 5-12 d), 86 (31%) had single ventricle anatomy, and 183 (67%) were classified as Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Category 4 or 5. Prolonged duration of mechanical ventilation occurred in 89 patients (32%). At each postoperative time point, the area under the curve for prolonged duration of mechanical ventilation was significantly greater for the Vasoactive-Ventilation-Renal score as compared to the ventilation index, Vasoactive-Inotrope Score, and serum lactate, with an area under the curve for peak Vasoactive-Ventilation-Renal score of 0.82 (95% CI, 0.77-0.88). On multivariable analysis, peak Vasoactive-Ventilation-Renal score was independently associated with prolonged duration of mechanical ventilation, odds ratio (per 1 unit increase): 1.08 (95% CI, 1.04-1.12). CONCLUSIONS In this multicenter cohort of neonates who underwent cardiac surgery, the Vasoactive-Ventilation-Renal score was a reliable predictor of postoperative outcome and outperformed more traditional measures of disease complexity and severity.
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99
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Mechak JT, Edwards EM, Morrow KA, Swanson JR, Vergales J. Effects of Gestational Age on Early Survivability in Neonates With Hypoplastic Left Heart Syndrome. Am J Cardiol 2018; 122:1222-1230. [PMID: 30292282 DOI: 10.1016/j.amjcard.2018.06.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/14/2018] [Accepted: 06/25/2018] [Indexed: 11/15/2022]
Abstract
Prematurity increases pre- and postoperative mortality in children with congenital heart disease. There are no large, multicentered, studies that have evaluated this relation specifically in neonates with hypoplastic left heart syndrome (HLHS). We sought to determine the impact of gestational age (GA) on survival to Stage 1 palliation surgery and hospital discharge in infants with HLHS. We reviewed data from 1,913 neonates with HLHS born at or transferred to a Vermont Oxford Network expanded member hospital in the United States from 2009 to 2014. Demographic, diagnostic, and surgical codes, and outcome data within the Vermont Oxford Network database were used to determine the effect of GA and birth weight on survival to Stage 1 palliation surgery and hospital discharge. Risk models were developed controlling for common confounders to determine the relative risk of GA on the observed outcomes. These data demonstrate that, when compared with 39-week infants, those born at earlier GA were less likely to survive until surgery; <34 weeks adjusted risk ratio (ARR) for survival: 0.47 (95% confidence interval 0.37 to 0.60), 34 to 35 weeks ARR 0.73 (0.62 to 0.87), and 36 to 37 weeks ARR 0.88 (0.83 to 0.94). Higher GA also positively correlated with survival to hospital discharge, although there was no difference in 34 to 35-week infants and 36 to 37-week infants. In conclusion, these data show that GA was an independent risk factor for survival to Stage 1 palliation surgery and survival to hospital discharge. However, there is no significant difference in survival to hospital discharge between infants born in 34 to 37 weeks gestation.
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Affiliation(s)
- Joseph T Mechak
- University of Virginia Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Charlottesville, Virginia.
| | - Erika M Edwards
- Vermont Oxford Network, Burlington, Vermont; University of Vermont, Department of Mathematics and Statistics, Burlington, Vermont; University of Vermont, Department of Pediatrics, Burlington, Vermont
| | | | - Jonathan R Swanson
- University of Virginia Children's Hospital, Department of Pediatrics, Division of Neonatology, Charlottesville, Virginia
| | - Jeffrey Vergales
- University of Virginia Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Charlottesville, Virginia
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Steurer MA, Baer RJ, Burke E, Peyvandi S, Oltman S, Chambers CD, Norton ME, Rand L, Rajagopal S, Ryckman KK, Feuer SK, Liang L, Paynter RA, McCarthy M, Moon‐Grady AJ, Keller RL, Jelliffe‐Pawlowski LL. Effect of Fetal Growth on 1-Year Mortality in Neonates With Critical Congenital Heart Disease. J Am Heart Assoc 2018; 7:e009693. [PMID: 30371167 PMCID: PMC6201429 DOI: 10.1161/jaha.118.009693] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/29/2018] [Indexed: 12/21/2022]
Abstract
Background Infants with critical congenital heart disease ( CCHD ) are more likely to be small for gestational age (GA). It is unclear how this affects mortality. The authors investigated the effect of birth weight Z score on 1-year mortality separately in preterm (GA <37 weeks), early-term (GA 37-38 weeks), and full-term (GA 39-42 weeks) infants with CCHD . Methods and Results Live-born infants with CCHD and GA 22 to 42 weeks born in California 2007-2012 were included in the analysis. The primary predictor was Z score for birth weight and the primary outcome was 1-year mortality. Multivariable logistic regression was used. Results are presented as adjusted odds ratios and 95% confidence intervals ( CIs ). The authors identified 6903 infants with CCHD . For preterm and full-term infants, only a Z score for birth weight <-2 was associated with increased mortality compared with the reference group ( Z score 0-0.5, adjusted odds ratio, 2.15 [95% CI , 1.1-4.21] and adjusted odds ratio, 3.93 [95% CI , 2.32-6.68], respectively). In contrast, in early-term infants, the adjusted odds ratios for Z scores <-2, -2 to -1, and -1 to -0.5 were 3.42 (95% CI , 1.93-6.04), 1.78 (95% CI , 1.12-2.83), and 2.03 (95% CI , 1.27-3.23), respectively, versus the reference group. Conclusions GA seems to modify the effect of birth weight Z score on mortality in infants with CCHD . In preterm and full-term infants, only the most severe small-for-GA infants ( Z score <-2) were at increased risk for mortality, while, in early-term infants, the risk extended to mild to moderate small-for-GA infants ( Z score <-0.5). This information helps to identify high-risk infants and is useful for surgical planning.
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Affiliation(s)
- Martina A. Steurer
- Department of PediatricsUniversity of California San FranciscoSan FranciscoCA
- Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCA
- California Preterm Birth InitiativeUniversity of California San FranciscoSan FranciscoCA
| | - Rebecca J. Baer
- California Preterm Birth InitiativeUniversity of California San FranciscoSan FranciscoCA
- Department of PediatricsUniversity of California San DiegoLa JollaCA
| | - Edmund Burke
- Department of PediatricsUniversity of California San FranciscoSan FranciscoCA
| | - Shabnam Peyvandi
- Department of PediatricsUniversity of California San FranciscoSan FranciscoCA
| | - Scott Oltman
- Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCA
- California Preterm Birth InitiativeUniversity of California San FranciscoSan FranciscoCA
| | | | - Mary E. Norton
- Department of Obstetrics, Gynecology, and Reproductive SciencesUniversity of California San FranciscoSan FranciscoCA
| | - Larry Rand
- Department of Obstetrics, Gynecology, and Reproductive SciencesUniversity of California San FranciscoSan FranciscoCA
| | - Satish Rajagopal
- Department of PediatricsUniversity of California San FranciscoSan FranciscoCA
| | - Kelli K. Ryckman
- Department of EpidemiologyCollege of Public HealthUniversity of IowaIowa CityIA
| | - Sky K. Feuer
- California Preterm Birth InitiativeUniversity of California San FranciscoSan FranciscoCA
| | - Liang Liang
- Department of GeneticsStanford UniversityStanfordCA
| | - Randi A. Paynter
- Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCA
- California Preterm Birth InitiativeUniversity of California San FranciscoSan FranciscoCA
| | - Molly McCarthy
- California Preterm Birth InitiativeUniversity of California San FranciscoSan FranciscoCA
| | - Anita J. Moon‐Grady
- Department of PediatricsUniversity of California San FranciscoSan FranciscoCA
| | - Roberta L. Keller
- Department of PediatricsUniversity of California San FranciscoSan FranciscoCA
| | - Laura L. Jelliffe‐Pawlowski
- Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCA
- California Preterm Birth InitiativeUniversity of California San FranciscoSan FranciscoCA
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