Abstract 16234: Twinning and Multiple Births: A Risk for Neonates With Congenital Heart Disease?
Background The impact of twinning and birth multiplicity for neonates with congenital heart disease is not known.
Methods All 1,618 infants admitted to our institution within 30 days of life for a congenital heart defect since 2000 were analyzed. Pregnancy, delivery and clinical notes were scrutinized on all. Survival differences between multiples and singletons were explored using risk-adjusted parametric multivariate regression. In order to further adjust for important differences, logistic differences between multiples and singletons were used to propensity-match.
Results The prevalence of birth multiplicity was 5.5% (table). Multiplicity was uncommon in d-TGA (P=.02), and especially frequent in RV hypoplastic lesions (P=.02). Late survival for the cohort was ~83% at 10 years. Multiplicity was an important perinatal determinant of poor prognosis (P=.0003); interestingly monochorionic multiplicity tended to be more protective versus di- or trichorionic (P=.09). Other independent risk factors for death included LV hypoplastic lesions (P<.0001) and AVSD (P<.0001). Statistical models revealed much of the covariance of mulitplicity to be attributed to low birth weight. Multiples (N=89) and singletons (N=89) were therefore matched. They were statistically identical, including diagnosis, birth weight, gestational ages, syndromic features and baseline non-cardiac co-morbidities. Perinatal determinants of death included mulitplicity (P=.03) and younger gestational age (P=.002), whereas mono-chorionic mulitplicity was protective (P=.04) (figure). Birth weight was unimportant in this matched population.
Conclusions Birth multiplicity represents an independent risk factor for death - irrespective of birth weight. This risk may not include mono-chorionic multiple. With the increasing advent of prenatal cardiac diagnosis, the value of multiplicity in prognostication will increase.
- © 2011 by American Heart Association, Inc.