Epidemiological profile and factors associated with in-hospital mortality in neonatal heart failure: a secondary analysis of GBD 2021 and a Chinese multicenter cohort

To characterize the epidemiological burden of heart failure among neonates in China and examine factors associated with in-hospital mortality in the neonatal subgroup of a pre-existing Chinese pediatric heart failure cohort. We analyzed 1990–2021 estimates from the Global Burden of Disease (GBD) 2021 Results Tool by selecting heart failure as a Level 1 impairment and then restricting age to the neonatal period. The clinical component was a secondary analysis of 212 neonates from a pre-existing pediatric heart failure cohort that enrolled patients at 30 centers in 20 Chinese provinces during 2013–2022. In-hospital death occurred in 23 patients. A parsimonious Firth penalized logistic model included four clinically selected baseline variables: postnatal age, gestational age, complex congenital heart anomaly (CHA), and severe infection at admission; missing-data, center-clustering, and internal-validation analyses were performed. Between 1990 and 2021, the neonatal heart failure prevalence and YLD rates in China increased by 8.64% and 8.57%, respectively; the estimated annual percentage change was 0.38% for both measures. CHA were the leading contributing cause in 2021. In the clinical cohort, 23 of 212 neonates (10.8%) died in hospital. The primary complete-case analysis included 184 neonates and 23 deaths. Point estimates suggested lower odds of death with older postnatal age (OR 0.95, 95% CI 0.89–1.01) and greater gestational age (OR 0.92, 95% CI 0.80–1.05), and higher odds with complex CHA (OR 2.28, 95% CI 0.68–7.59) and severe infection at admission (OR 2.68, 95% CI 0.81–8.94); all confidence intervals included the null. The apparent AUC was 0.736 (bootstrap 95% CI 0.628–0.832), and the optimism-corrected AUC was 0.695. GBD estimates indicate a modest increase in neonatal heart failure burden in China, with CHA as the leading attributed cause. In the clinical secondary analysis, associations with in-hospital mortality were imprecisely estimated and should be considered exploratory. Larger prospectively characterized cohorts are needed before these factors are used for risk stratification.