# Antenatal and Preoperative Factors Associated with 2-Year Outcome of Preterm Newborns with Biventricular Complex Congenital Heart Defects: A 23-Year Cohort Study

## TL;DR

This study finds that certain antenatal and preoperative factors are linked to worse outcomes in preterm babies with complex heart defects up to age 2.

## Contribution

The study identifies specific antenatal and preoperative risk factors for long-term outcomes in preterm infants with biventricular complex congenital heart defects.

## Key findings

- Chorioamnionitis and prolonged rupture of membranes are linked to worse long-term outcomes in preterm infants with complex heart defects.
- Maternal diabetes and antenatal diagnosis of complex congenital heart defects are associated with adverse neurodevelopmental outcomes.
- Eight percent of preterm newborns with complex heart defects died by age 2, and 9% had disabilities.

## Abstract

What are the main findings?
Chorioamnionitis and prolonged rupture of membranes are associated with worse long-term outcomes in preterm newborns with biventricular complex congenital heart defect up to 2 years of age.Maternal diabetes and antenatal diagnosis of complex congenital heart defects are associated with adverse neurodevelopmental outcomes.

Chorioamnionitis and prolonged rupture of membranes are associated with worse long-term outcomes in preterm newborns with biventricular complex congenital heart defect up to 2 years of age.

Maternal diabetes and antenatal diagnosis of complex congenital heart defects are associated with adverse neurodevelopmental outcomes.

What are the implications of the main finding?
The findings of an association between antenatal, pre-operative and operative variables and long-term outcomes up to 2 years corrected age among preterm newborns with biventricular complex congenital heart defect need further prospective multicenter cohort studies to examine whether these outcomes persisted or changed during longer follow-up study periods.The results of such studies would guide clinicians toward optimization of maternal diabetes control, prevention, and aggressive early treatment of chorioamnionitis and prolonged rupture of membranes, with planned delivery at tertiary cardiac centers.

The findings of an association between antenatal, pre-operative and operative variables and long-term outcomes up to 2 years corrected age among preterm newborns with biventricular complex congenital heart defect need further prospective multicenter cohort studies to examine whether these outcomes persisted or changed during longer follow-up study periods.

The results of such studies would guide clinicians toward optimization of maternal diabetes control, prevention, and aggressive early treatment of chorioamnionitis and prolonged rupture of membranes, with planned delivery at tertiary cardiac centers.

Introduction: To explore whether antenatal and preoperative factors predict disability-free survival of preterm newborns with biventricular complex congenital heart defects (CHD). Methods: Retrospective cohort study, using the prospectively designed database of Complex Pediatric Therapies Follow Up Program and a chart review of mother–newborn dyads, born under 37 weeks’ gestation with biventricular complex CHD, between 1997 and 2019, who had open heart surgery up to 6 weeks corrected age. Surviving children had neurodevelopmental assessments between 18 and 24 months corrected age. Bayley Scales of Infant Development, 2nd edition, and Bayley Scales of Infant and Toddler Development, 3rd edition, assessed cognitive, language, and motor skills; Adaptive Behavior Assessment System, 3rd edition, assessed adaptive skills. Univariate and multivariate analyses assessed predictors of mortality, disability (cerebral palsy, visual impairment, permanent hearing loss), and neurodevelopmental delay. Results: Of 84 preterm newborns (34.6 ± 2.1 weeks’ gestation, 2321 ± 609 g, 57% males), 8 (9.5%) died by 2 years of age; 69 (91%) survived without and 7 (9%) with disability. Chorioamnionitis was associated with death [Hazard ratio 7.92 (95% CI 1.3, 33.3), p = 0.025]; prolonged rupture of membranes was associated with disability [Odds Ratio 9.7 (95% CI 1.99, 46.9), p = 0.005]. Maternal diabetes, antenatal diagnosis of CCHD, birth head circumference, cardiopulmonary resuscitation, and chromosomal anomalies were associated with adverse neurodevelopment. Conclusions: Chorioamnionitis and prolonged rupture of membranes are associated with worse outcomes in preterm newborns with biventricular complex CHD up to 2 years of age. Adverse neurodevelopmental outcomes are associated with maternal diabetes and antenatal diagnosis of CCHD. Prospective studies are needed to confirm these results.