title: Increased morbidity and mortality in very preterm/VLBW infants with congenital heart disease.
abstract: OBJECTIVE
  To study the association between congenital heart diseases (CHD) and in-hospital mortality and morbidity of very preterm/very low birth weight (VLBW) infants.
  
  
  METHODS
  The area-based prospective cohort study ACTION included all infants with gestational age (GA) 22-31 weeks or birth weight <1,500 g admitted to neonatal care between July 2003 and June 2005 in six Italian regions (n = 3,684). CHD were coded according to ICD9-CM. Cluster multivariable logistic regression analyses were used to assess the relationship between CHD and mortality and selected morbidities [neonatal infection, ultrasound brain abnormalities, retinopathy of prematurity (ROP), and bronchopulmonary dysplasia (BPD)] adjusting for potential confounders.
  
  
  RESULTS
  Seventy-one patients had CHD [19.3 ‰, 95 % confidence interval (CI) 15.1-24.2 ‰]. The most common lesions were isolated atrial and ventricular septal defects (31.1 and 26.8 %, respectively), pulmonary valvar stenosis (12.7 %), and tetralogy of Fallot (5.6 %). Compared with other infants, CHD patients showed significantly higher GA and frequency of small for gestational age (SGA, i.e., birth weight ≤3rd centile). After adjustment for GA, sex, SGA, presence of extracardiac malformations or chromosomal anomalies, and region of birth, CHD patients had a significantly higher likelihood of infection, BPD, ROP, and, after 27 weeks gestation only, hospital mortality. The increased risk of ROP appeared to be partly due to infection.
  
  
  CONCLUSIONS
  In very preterm/VLBW infants CHD are more prevalent than in the general liveborn population, and confer an increased risk of death and serious morbidities independently of other risk factors. These results may be useful to better tailor prognostic assessment and diagnostic and therapeutic interventions for these children.
authors.affiliation: Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Polito
authors.forename: Simone
authors.initials: S
authors.lastname: Piga
authors.forename: Paola E
authors.initials: PE
authors.lastname: Cogo
authors.forename: Carlo
authors.initials: C
authors.lastname: Corchia
authors.forename: Virgilio
authors.initials: V
authors.lastname: Carnielli
authors.forename: Monica
authors.initials: M
authors.lastname: Da Frè
authors.forename: Domenico
authors.initials: D
authors.lastname: Di Lallo
authors.forename: Isabella
authors.initials: I
authors.lastname: Favia
authors.forename: Luigi
authors.initials: L
authors.lastname: Gagliardi
authors.forename: Francesco
authors.initials: F
authors.lastname: Macagno
authors.forename: Silvana
authors.initials: S
authors.lastname: Miniaci
authors.forename: Marina
authors.initials: M
authors.lastname: Cuttini
mesh_terms: D005260:Female; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000150:complications* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D007558:Italy / Q000453:epidemiology; D008297:Male; D009017:Morbidity; D015995:Prevalence; D011446:Prospective Studies
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