Gestational Age at Birth and Outcomes After Neonatal Cardiac Surgery: An Analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database | Journal Scan

Study Questions:

What is the relationship between gestational age and outcomes of infants undergoing cardiac surgery?

Methods:

A multicenter retrospective review was performed, using the Society of Thoracic Surgeons Congenital Heart Surgery Database. All infants undergoing cardiac surgery between 2011 and 2012 were included. Outcome measures include in-hospital mortality, postoperative length of stay, and complications. Multivariable logistic regression was used to adjust for patient characteristics.

Results:

A total of 4,784 neonates from 92 hospitals were studied. Approximately 48% were born before 39 weeks gestation, including 31% at 37-38 weeks. When compared with infants born at 39.5 weeks, birth at 37 weeks gestation was associated with higher in-hospital mortality, with an adjusted odds ratio (95% confidence interval) of 1.34 (1.05-1.71; p = 0.02). Additionally, complication rates were higher and postoperative length of stay was prolonged for those born at 37 and 38 weeks gestation (p < 0.01). Additionally, mortality was higher and postoperative length of stay was longer for those born at 34-36 weeks gestation (adjusted p ≤ 0.0003).

Conclusions:

The authors concluded that birth during the early term period (37-38 weeks gestation) is associated with worse outcomes after neonatal cardiac surgery. Elective early term delivery of infants with known congenital heart disease should be discouraged.

Perspective:

Previous studies have demonstrated that in infants without congenital heart disease, early term birth is associated with a higher risk of complications including respiratory complications, need for neonatal intensive care unit admission, hypoglycemia, and low 5-minute APGAR scores. Despite this, elective early-term delivery is common practice for patients with and without congenital heart disease. While the results in this study were adjusted for many patient characteristics, the study design did not allow for the identification of factors that determined the timing of delivery. This study demonstrates that delivery at 39-40 weeks gestation is associated with the lowest rates of morbidity and mortality. Elective delivery prior to 39 weeks gestational age without compelling medical indications should be avoided.

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and CHD and Pediatrics, CHD and Pediatrics and Interventions, CHD and Pediatrics and Quality Improvement

Keywords: Cardiac Surgical Procedures, Delivery, Obstetric, Gestational Age, Hospital Mortality, Hypoglycemia, Infant, Newborn, Infant, Premature, Diseases, Intensive Care Units, Length of Stay, Morbidity, Outcome Assessment (Health Care), Parturition, Term Birth


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