Impact of Maternal–Fetal Environment on Mortality in Children With Single Ventricle Heart Disease

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Julie S. Moldenhauer¹  Jing Huang²  Mary E. Putt²  Steven M. Kawut³  Samuel Parry⁴  Jill J. Savla⁵  Laura Mercer‐Rosa⁵  Samantha Reilly⁵  Olivia Youman⁵  Jack Rychik⁵  J. William Gaynor⁶ 

[1] Center for Fetal Diagnosis and Treatment Children’s Hospital of Philadelphia and Perelman School of Medicine University of Pennsylvania Philadelphia PA;Department of Biostatistics, Epidemiology, and Informatics Perelman School of Medicine University of Pennsylvania Philadelphia PA;Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia PA;Department of Obstetrics and Gynecology Perelman School of Medicine University of Pennsylvania Philadelphia PA;Division of Cardiology Department of Pediatrics, Children’s Hospital of Philadelphia and Perelman School of Medicine University of Pennsylvania Philadelphia PA;Division of Cardiothoracic Surgery Department of Surgery, Children’s Hospital of Philadelphia and Perelman School of Medicine University of Pennsylvania Philadelphia PA;

关键词: hypoplastic left heart syndrome;    congenital heart disease;    preeclampsia/pregnancy;    fetal programming;    fetal development;    Stage 1 Norwood procedure;   

DOI  :  10.1161/JAHA.120.020299

来源: DOAJ

【 摘 要 】

BACKGROUND Children with single ventricle heart disease have significant morbidity and mortality. The maternal–fetal environment (MFE) may adversely impact outcomes after neonatal cardiac surgery. We hypothesized that impaired MFE would be associated with an increased risk of death after stage 1 Norwood reconstruction. METHODS AND RESULTS We performed a retrospective cohort study of children with hypoplastic left heart syndrome (and anatomic variants) who underwent stage 1 Norwood reconstruction between 2008 and 2018. Impaired MFE was defined as maternal gestational hypertension, preeclampsia, gestational diabetes, and/or smoking during pregnancy. Cox proportional hazards regression models were used to investigate the association between impaired MFE and death while adjusting for confounders. Hospital length of stay was assessed with the competing risk of in‐hospital death. In 273 children, the median age at stage 1 Norwood reconstruction was 4 days (interquartile range [IQR], 3–6 days). A total of 72 children (26%) were exposed to an impaired MFE; they had more preterm births (18% versus 7%) and a greater percentage with low birth weights <2.5 kg (18% versus 4%) than those without impaired MFE. Impaired MFE was associated with a higher risk of death (hazard ratio [HR], 6.05; 95% CI, 3.59–10.21; P<0.001) after adjusting for age at surgery, Hispanic ethnicity, genetic syndrome, cardiac diagnosis, surgeon, and birth era. Children with impaired MFE had almost double the risk of prolonged hospital stay (HR, 1.95; 95% CI, 1.41–2.70; P<0.001). CONCLUSIONS Children exposed to an impaired MFE had a higher risk of death following stage 1 Norwood reconstruction. Prenatal exposures are potentially modifiable factors that can be targeted to improve outcomes after pediatric cardiac surgery.

【 授权许可】

Unknown