Risk factors of mortality in preterm and early-term neonates following surgery for CHD

Background: Dynamic, data-driven predictors of perioperative mortality risks in preterm/early-term neonates with CHD undergoing cardiac surgery in the first 24 months of life are limited. Aims: To identify risk factors of mortality in the first 24 months of life for pre/early-term neonates with CHD. Methods: Retrospective cohort study of patients <39 weeks of gestation undergoing cardiac surgery within 24 months of life from 2013–2020 at a tertiary care centre. Independent risk factors of mortality within 24 months of life were determined by multivariable Cox regression analysis. Results: Among the 205 neonates, 33 (16.1%) died within 24 months. Multivariable analysis revealed that high-frequency ventilation (hazard ratio = 5.15; 95% confidence interval): 2.51, 10.6; p < 0.001), extracorporeal membrane oxygenation support (hazard ratio = 5.77; 95% confidence interval: 2.67, 12.5; p < 0.001), and CHD with a palliated circulation (hazard ratio = 6.07; 95% confidence interval: 2.84, 13; p < 0.001) were significant independent risk factors of mortality at any time during the index hospitalisation or the first 24 months of life. Conclusions: Identifying and re-evaluating risk factors of mortality for preterm/early-term neonates with CHD at any time during the index hospitalisation or the first 24 months of life may guide resource allocation and therapeutic interventions. Trial registration number and date of registration: IRB P00028833 5/2/2018. Retrospectively registered.