Perinatal Decision Making For Preterm Infants With Congenital Heart Disease: Determinable Risk Factors For Mortality.

Title

Perinatal Decision Making For Preterm Infants With Congenital Heart Disease: Determinable Risk Factors For Mortality.

Creator

Lynema S; Fifer C; Laventhal N

Identifier

DOI: 10.1007/s00246-016-1374-y

Publisher

Pediatric Cardiology.

Date

2016

Subject

Cardiac & Cardiovascular Systems; Birth-weight Infants; Necrotizing Enterocolitis; Defects; Pediatrics; Vascular Surgery
Antenatal Counseling; Congenital Heart Disease; Premature; Trial Of Therapy

Description

For premature infants with congenital heart disease (CHD), it may be unclear when the burdens of treatment outweigh potential benefits. Parents may thus have to choose between comfort care at birth and medical stabilization until surgical repair is feasible. Better defined outcome data, including risk factors for mortality, are needed to counsel expectant parents who are considering intensive care for premature infants with CHD. We sought to evaluate outcomes in this population to inform expectant parents considering intensive versus palliative care at birth. We performed a retrospective cohort study of infants born <34 weeks who received intensive care with critical or moderately severe CHD predicted to require surgery in the neonatal period or the first 6 months of life. 46 % of 54 infants survived. Among non-survivors, 74 % died prior to surgery (median age 24 days). Of the infants that underwent surgery, 75 % survived. Survival was lower among infants <32 weeks gestational age (GA) (p = 0.013), with birth weight (BW) <1500 g (p = 0.011), or with extra-cardiac anomalies (ECA) (p = 0.015). GA and ECA remained significant risk factors for mortality in multiple logistic regression analysis. In summary, GA < 32 weeks, BW < 1500 g, and ECA are determinable prenatally and were significant risk factors for mortality. The majority of infants who survived to cardiac intervention survived neonatal hospitalization, whereas most of the infants who died did so prior to surgery. For some expectant parents, this early declaration of mortality may support a trial of intensive care while avoiding burdensome interventions.

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Citation List Month

April 2016 List

Citation

Lynema S; Fifer C; Laventhal N, “Perinatal Decision Making For Preterm Infants With Congenital Heart Disease: Determinable Risk Factors For Mortality.,” Pediatric Palliative Care Library, accessed January 27, 2022, https://pedpalascnetlibrary.omeka.net/items/show/10473.

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