Congenital: Perioperative Management
Association between Z-score for birth weight and postoperative outcomes in neonates and infants with congenital heart disease

https://doi.org/10.1016/j.jtcvs.2021.01.065Get rights and content
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Abstract

Objective

We hypothesized that infants with fetal growth restrictions have increased mortality and morbidity after congenital heart disease surgery.

Methods

The study included patients in The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010-2016) who underwent cardiac surgery at a corrected gestational age of ≤44 weeks. Patients were classified as severely (birth weight Z-score −4 to −2), moderately (Z-score −2 to −1), and mildly growth restricted (Z-score −1.0 to −0.5) and compared with a reference population (Z-score 0-0.5). Multivariable logistic regression clustering on center was used to evaluate the association of birth weight Z-score with operative mortality and postoperative complications and its interaction with gestational age was assessed.

Results

In 25,244 patients, operative mortality was 8.6% and major complications occurred in 19.4%. Compared with the reference group, the adjusted odds ratio (AOR) of mortality was increased in infants with severe (AOR, 2.4; 95% confidence interval [CI], 2.0-3.0), moderate (AOR, 1.7; 95% CI, 1.4-2.0), and mild growth restriction (AOR, 1.4; 95% CI, 1.2-1.6). The AOR for major postoperative complications was increased for severe (AOR, 1.4; 95% CI, 1.2-1.7) and moderate growth restriction (AOR, 1.2; 95% CI, 1.1-1.4). There was significant interaction between birth weight Z-score and gestational age (P = .007).

Conclusions

Even birth weight Z-scores slightly below average are independent risk factors for mortality and morbidity in infants who undergo cardiac surgery. The strongest association between poor fetal growth and operative mortality exists in early-term infants. These novel findings might account for some of the previously unexplained variation in cardiac surgical outcomes.

Graphical abstract

Methods, main results, and implications of this study. This was a retrospective study using The Society of Thoracic Surgeons database to evaluate Z-score for birth weight as a predictor for mortality and postoperative complications in neonates who underwent congenital heart surgery.

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Key Words

congenital heart disease
fetal growth restriction
Z-score for birth weight
postoperative outcomes

Abbreviations and Acronyms

AOR
adjusted odds ratio
CHD
congenital heart disease
CI
confidence interval
CPB
cardiopulmonary bypass
GA
gestational age
PLOS
postoperative hospital length of stay
STS
The Society of Thoracic Surgeons
STS-CHSD
The Society of Thoracic Surgeons Congenital Heart Surgery Database

Cited by (0)

Funds from the Department of Cardiac Surgery and the Department of Pediatrics at University of California San Francisco were used to pay for the Participant User File (PUF) provided by The Society of Thoracic Surgeons (STS). Dr Peyvandi is supported by the National Institutes of Health (K23 NS099422).