Abstract 2000: Timing of Delivery and Outcomes in Neonates With Critical Congenital Heart Disease
Objective: Recent studies have shown increased morbidity in neonates without birth defects who were delivered at 37–386/7 weeks gestation. We sought to determine the association between gestational age at delivery and adverse outcomes in neonates with critical congenital heart disease (CCHD, defined as the need for surgical or catheter intervention before 28 days age), with particular interest in those born at 37–386/7 weeks.
Methods: We studied 942 consecutive neonates who had CCHD, a known gestational age, and were admitted to our CICU from 6/02 –12/08. Gestational age was stratified into 5 groups: >41, 39 – 406/7, 37–386/7, 34 –366/7 and <34 weeks. Multivariate logistic regression analyses were used to evaluate mortality and a composite morbidity variable (RDS; CPR; ECMO; infection; CNS injury; unplanned reintubation, reop., interventional cath or ICU readmit; disposition to other hospital; hospital readmit <30 days). Multivariate Poisson regression was used to evaluate duration of ventilation, ICU stay, and hospitalization. Mortality was adjusted for prenatal diagnosis, non-reassuring fetal status just prior to delivery, non-cardiac structural anomalies, RACHS-1 category and CPB time; these covariates along with chromosomal syndrome and small for gestational age were used to adjust morbidity and duration of stay outcomes.
Results: Compared to the reference group delivered at 39 – 406/7 weeks, the 37–386/7 week group had increased adjusted mortality, longer duration of ventilation, and a trend for more ICU days (Table⇓). Patients born at >41 or <37 weeks also had greater adjusted mortality; those born <37 weeks had increased morbidity, ventilator, ICU and hospital days (Table⇓).
Conclusions: For neonates with CCHD, delivery <39 weeks is associated with significantly greater adjusted odds of mortality and more resource utilization. With respect to early mortality and morbidity, the ideal gestational age for delivery for these patients may be 39 – 406/7 weeks.