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Impact of preterm birth on infant mortality for newborns with congenital heart defects: The EPICARD population-based cohort study

Enora Laas 1 Nathalie Lelong 1 Pierre-yves Ancel 1 Damien Bonnet 2 Lucile Houyel 3 Jean-François Magny 2 Thibaut Andrieu 1 François Goffinet 4, 1 Babak Khoshnood 1, * 
* Corresponding author
1 CRESS - U1153 - Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique
UPD5 - Université Paris Descartes - Paris 5, CRESS (U1153 / UMR_A_1125 / UMR_S_1153) - Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité
Abstract : AbstractBackgroundCongenital heart defects (CHD) and preterm birth (PTB) are major causes of infant mortality. However, limited data exist on risk of mortality associated with PTB for newborns with CHD. Our objective was to assess impact of PTB on risk of infant mortality for newborns with CHD, while taking into account the role of associated anomalies and other potentially confounding factors.MethodsWe used data on 2172 live births from a prospective population-based cohort study of CHD (the EPICARD Study) and compared neonatal, post-neonatal and overall infant mortality for infants born at <32, 32–34 and 35–36 weeks vs. those born at term (37–41 weeks).ResultsPreterm newborns had a 3.8-fold higher risk of infant death (17.9%) than term newborns (4.7%), RR 3.8, 95%CI 2.7–5.2; the risk associated with PTB was more than four-fold higher for neonatal (RR 4.3, 95% CI 2.9–6.6) and three-fold higher for post-neonatal deaths (RR 3.0, 95% CI 1.7–5.2). Survival analysis showed that newborns <35 weeks had a higher risk of mortality, which decreased but persisted after exclusion of associated anomalies and adjustment for potential confounders.ConclusionsPreterm birth is associated with an approximately four-fold higher risk of infant mortality for newborns with CHD. This excess risk appears to be mostly limited to newborns <35 weeks of gestation and is disproportionately due to early deaths.
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Enora Laas, Nathalie Lelong, Pierre-yves Ancel, Damien Bonnet, Lucile Houyel, et al.. Impact of preterm birth on infant mortality for newborns with congenital heart defects: The EPICARD population-based cohort study. BMC Pediatrics, BioMed Central, 2016, 17 (1), pp.124. ⟨10.1186/s12887-017-0875-z⟩. ⟨inserm-01525478⟩



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