title: Clinical outcomes in very low birth weight infants with major congenital heart defects.
abstract: BACKGROUND
  The combination of major congenital heart disease (CHD) and prematurity is associated with poor prognosis, but previous studies have not fully characterized morbidity and mortality in this population. We conducted a retrospective cohort study of very low birth weight (VLBW) infants with major CHD to describe outcomes, including mortality, over time.
  
  
  METHODS
  We included all infants <1500 g birth weight with major CHD discharged from Pediatrix Medical Group neonatal intensive care units from 1997 to 2012. We report incidences of major CHD in VLBW infants and compare mortality and morbidity by infant birth weight, type of major CHD, and time period.
  
  
  RESULTS
  Of 105,539 VLBW infants, 299 (0.3%) were diagnosed with 15 different major CHDs. Coarctation of the aorta (n=67, 22%), atrioventricular septal defect (n=58, 19%), and tetralogy of Fallot (n=53, 18%) were the most common major CHDs identified. Overall mortality was 163/299 (55%). Mortality was ≥70% for 10 lesions and <30% for isolated aortic valve stenosis (6/30, 20%). Mortality in infants with major CHD did not significantly change over time: 76/133 (57%) in 1997-2005, 49/95 (52%) in 2006-2009, and 38/71 (54%) in 2010-2012 (p=0.70). The majority of infants suffered ≥1 comorbidity or died (218/299, 73%).
  
  
  CONCLUSIONS
  Major CHD is associated with high morbidity and mortality. While mortality varies by lesion, overall survival and incidence of major morbidity have not improved over time.
authors.affiliation: Texas A&M University, College Station, TX, USA.
authors.forename: Anna W
authors.initials: AW
authors.lastname: Anderson
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA; Department of Pediatrics, Duke University, Durham, NC, USA.
authors.forename: P Brian
authors.initials: PB
authors.lastname: Smith
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Corey
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA; Department of Pediatrics, Duke University, Durham, NC, USA.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Hill
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA; Department of Pediatrics, Duke University, Durham, NC, USA.
authors.forename: Kanecia O
authors.initials: KO
authors.lastname: Zimmerman
authors.affiliation: Pediatrix Medical Group, Sunrise, FL, USA.
authors.forename: Reese H
authors.initials: RH
authors.lastname: Clark
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA; Department of Pediatrics, Duke University, Durham, NC, USA. Electronic address: christoph.hornik@dm.duke.edu.
authors.forename: Christoph P
authors.initials: CP
authors.lastname: Hornik
mesh_terms: D001724:Birth Weight; D015331:Cohort Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D009017:Morbidity; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: Congenital heart defect; Morbidity; Mortality; Prematurity; Very low birth weight