What is the clinical evidence from this study?

Study design: Cohort. Population: Congenital heart disease (n=5070). Intervention: Very preterm birth (<32 weeks) vs. Term birth (37-41 weeks). Primary outcome: Mortality (aHR 6.85, 95% CI 5.11-9.18, p=<0.001).

What question did this study set out to answer?

To identify predictors of mortality and estimate five-year conditional survival based on gestational age and birth weight in individuals with congenital heart disease.

July 1, 2017Journal of the American Heart AssociationOpen Access

Survival, by Birth Weight and Gestational Age, in Individuals With Congenital Heart Disease: A Population‐Based Study

Q: What question did this study set out to answer?

To identify predictors of mortality and estimate five-year conditional survival based on gestational age and birth weight in individuals with congenital heart disease.

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Key result

Very preterm birth (<32 weeks) significantly increased the risk of mortality in children with congenital heart disease compared to term birth (aHR 6.85).

Population

5,070 cases of congenital heart disease born during 1985–2003 and notified to the Northern Congenital…

Design

Cohort

Follow-up

5 years

Authors

KBKate BestUniversity of Leeds PTPeter W. G. TennantUniversity of Leeds JRJudith RankinNewcastle University

Discussion

Member takes

Implication

May prompt closer monitoring of very preterm CHD infants; extends observational prognostic data without establishing causality.

Key Points

To identify predictors of mortality and estimate five-year conditional survival based on gestational age and birth weight in individuals with congenital heart disease.
Analyzed records of individuals with congenital heart disease (N=5070) born during 1985–2003 in the Northern Congenital Abnormality Survey and linked them to national mortality records in 2008.
Applied Royston–Parmar regression to evaluate predictors of mortality and generate 5-year conditional survival estimates for isolated congenital heart disease.
Year of birth, gestational age, birth weight, and extracardiac anomalies were independently associated with mortality (all P ≤ 0.001).
Five-year survival for infants born at term (37–41 weeks) with average birth weight in 2003 was 96.3% (95% CI, 95.6–97.0).
Survival ranged from 78.8% (95% CI, 72.8–99.1) in very preterm (<32 weeks), low-birth-weight infants to 97.9% (95% CI, 96.8–99.1%) in post-term (≥42 weeks), high-birth-weight infants.

Study Design

Type

Cohort (n=5,070)

Multicenter

Structured PICO

Population

5,070 live-born infants with congenital heart disease in the North of England between 1985 and 2003, followed for up to 23 years to assess long-term survival.

Outcome

5-year survival conditional on gestational age at delivery, birth weight, and year of birthhard clinical

Main Result

Hazard Ratio: 6.85 (95% CI 5.11–9.18)

p-value: p=<0.001

Gestational age and birth weight are strong independent predictors of 5-year survival in children with congenital heart disease, providing important prognostic information for prenatal counseling and postnatal care.

Limitations

Lack of data on surgical and medical interventions
Lack of data on morbidities such as sepsis or pulmonary hypertension
Inability to confirm whether a cardiac event was the specific cause of death
Poor recording of ethnicity and parity
Limited statistical power to assess uncommon features like high birth weight or post-term birth

Cite This Study

Best et al. (2017) conducted a cohort in Congenital heart disease (n=5,070). Very preterm birth (<32 weeks) vs. Term birth (37-41 weeks) was evaluated on Mortality (aHR 6.85, 95% CI 5.11-9.18, p=<0.001). Very preterm birth (<32 weeks) significantly increased the risk of mortality in children with congenital heart disease compared to term birth (aHR 6.85).

synapsesocial.com/papers/6a96b889132cd8a75e5797b6 https://doi.org/10.1161/jaha.116.005213

Topics

Congenital heart disease adults

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Survival, by Birth Weight and Gestational Age, in Individuals With Congenital Heart Disease: A Population‐Based Study

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Survival, by Birth Weight and Gestational Age, in Individuals With Congenital Heart Disease: A Population‐Based Study

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

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