The Effect of Late Preterm Birth on Mortality of Infants with Hypoplastic Left Heart Syndrome

Abstract

Objectives We evaluated the effect of late preterm (34 to 36 weeks' gestation) delivery on hospital mortality of infants with hypoplastic left heart syndrome (HLHS).

Study Design Retrospective review of records of infants born at or after 34 weeks with no other lethal anomalies, cared for in a single tertiary perinatal center between 2002 and 2009. Factors associated with death prior to discharge from the hospital were ascertained using univariate and multivariate analyses.

Results Of the 243 infants with HLHS, 35 were late preterm and 208 were ≥37 weeks (term). Using logistic regression analysis, late preterm delivery (odds ratio [OR] 2.95; 95% confidence interval [CI] 1.35 to 6.45), the presence of other major cardiac defects (OR 3.76; 95% CI 1.31 to 10.81), and the presence of noncardiac congenital anomalies (OR 6.13; 95% CI 1.43 to 26.22) were independently associated with hospital death.

Conclusion Late preterm birth of infants with HLHS was independently associated with an increased risk of hospital death compared with those delivered at term.

Keywords

prematurity - complications - mortality - counseling - neonatal

• References

• 1 Morris CD, Outcalt J, Menashe VD. Hypoplastic left heart syndrome: natural history in a geographically defined population. Pediatrics 1990; 85: 977-983
• 2 Hirsch JC, Copeland G, Donohue JE, Kirby RS, Grigorescu V, Gurney JG. Population-based analysis of survival for hypoplastic left heart syndrome. J Pediatr 2011; 159: 57-63
• 3 Stasik CN, Gelehrter S, Goldberg CS, Bove EL, Devaney EJ, Ohye RG. Current outcomes and risk factors for the Norwood procedure. J Thorac Cardiovasc Surg 2006; 131: 412-417
• 4 Jacobs JP, O'Brien SM, Chai PJ, Morell VO, Lindberg HL, Quintessenza JA. Management of 239 patients with hypoplastic left heart syndrome and related malformations from 1993 to 2007. Ann Thorac Surg 2008; 85: 1691-1696 ; discussion 1697
• 5 Curzon CL, Milford-Beland S, Li JS , et al. Cardiac surgery in infants with low birth weight is associated with increased mortality: analysis of the Society of Thoracic Surgeons Congenital Heart Database. J Thorac Cardiovasc Surg 2008; 135: 546-551
• 6 Gaynor JW, Mahle WT, Cohen MI , et al. Risk factors for mortality after the Norwood procedure. Eur J Cardiothorac Surg 2002; 22: 82-89
• 7 Swenson AW, Dechert RE, Schumacher RE, Attar MA. The effect of late preterm birth on mortality of infants with major congenital heart defects. J Perinatol 2012; 32: 51-54
• 8 Bell MJ, Ternberg JL, Feigin RD , et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187: 1-7
• 9 Rychik J, Szwast A, Natarajan S , et al. Perinatal and early surgical outcome for the fetus with hypoplastic left heart syndrome: a 5-year single institutional experience. Ultrasound Obstet Gynecol 2010; 36: 465-470
• 10 Pizarro C, Davis DA, Galantowicz ME, Munro H, Gidding SS, Norwood WI. Stage I palliation for hypoplastic left heart syndrome in low birth weight neonates: can we justify it?. Eur J Cardiothorac Surg 2002; 21: 716-720
• 11 Bove EL. Current status of staged reconstruction for hypoplastic left heart syndrome. Pediatr Cardiol 1998; 19: 308-315
• 12 Engle WA, Tomashek KM, Wallman C ; Committee on Fetus and Newborn, American Academy of Pediatrics. “Late-preterm” infants: a population at risk. Pediatrics 2007; 120: 1390-1401
• 13 Bird TM, Bronstein JM, Hall RW, Lowery CL, Nugent R, Mays GP. Late preterm infants: birth outcomes and health care utilization in the first year. Pediatrics 2010; 126: e311-e319
• 14 Hibbard JU, Wilkins I, Sun L , et al; Consortium on Safe Labor. Respiratory morbidity in late preterm births. JAMA 2010; 304: 419-425
• 15 Patel A, Hickey E, Mavroudis C , et al. Impact of noncardiac congenital and genetic abnormalities on outcomes in hypoplastic left heart syndrome. Ann Thorac Surg 2010; 89: 1805-1813 ; discussion 1813–1814
• 16 Brown DW, Connor JA, Pigula FA , et al; Joint Council on Congenital Heart Disease National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC). Variation in preoperative and intraoperative care for first-stage palliation of single-ventricle heart disease: a report from the Joint Council on Congenital Heart Disease National Quality Improvement Collaborative. Congenit Heart Dis 2011; 6: 108-115
• 17 Baker-Smith CM, Neish SR, Klitzner TS , et al; Joint Council on Congenital Heart Disease National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC). Variation in postoperative care following stage I palliation for single-ventricle patients: a report from the Joint Council on Congenital Heart Disease National Quality Improvement Collaborative. Congenit Heart Dis 2011; 6: 116-127
• 18 Stevens TP, Chess PR, McConnochie KM , et al. Survival in early- and late-term infants with congenital diaphragmatic hernia treated with extracorporeal membrane oxygenation. Pediatrics 2002; 110: 590-596
• 19 Clark RH, Walker MW, Gauderer MW. Factors associated with mortality in neonates with gastroschisis. Eur J Pediatr Surg 2011; 21: 21-24
• 20 Russo MG, Paladini D, Pacileo G , et al. Changing spectrum and outcome of 705 fetal congenital heart disease cases: 12 years, experience in a third-level center. J Cardiovasc Med (Hagerstown) 2008; 9: 910-915
• 21 Gomez-Fifer CA. Hypoplastic left heart syndrome in the fetus: diagnostic features prior to birth and their impact on postnatal outcome. Prog Pediatr Cardiol 2006; 22: 53-60