Author + information
- Sara Pasquali,
- John M. Costello,
- Xia He,
- Jeffrey P. Jacobs,
- Kevin Hill,
- David S. Cooper,
- Carl L. Backer and
- Marshall Jacobs
Earlier gestational age (GA) at birth has been associated with worse outcome in neonates undergoing cardiac surgery, even at 37–38 weeks. However, prior studies have relied on administrative data or examination of single center cohorts. We used clinical registry data to evaluate whether this relationship held true across a large multicenter cohort.
Neonates <28 days who underwent cardiac surgery (2010–11) in the STS Congenital Heart Surgery Database were included. Multivariable logistic regression was used to evaluate the impact of GA at birth on in-hospital mortality, adjusting for other important patient characteristics (including weight, age and comorbidities), case complexity, and center effects. Post-operative length of stay (PLOS) was also evaluated.
4,784 neonates (92 centers) were included. Compared with an empirically derived 39.5 week GA reference level, birth at or before 37 weeks GA, but not 38 weeks, was associated with significantly higher adjusted mortality (Figure). Adjusted odds ratios (with 95% C.I.) for mortality were 1.53 (1.15–2.03, p=0.003) at 36 weeks, 1.34 (1.05-1.71, p=0.02) at 37 weeks, and 1.16 (0.93–1.45, p=0.19) at 38 weeks. Adjusted PLOS was significantly prolonged for those born at 38 weeks and earlier (all p<0.01).
Optimal outcomes following neonatal cardiac surgery are achieved with birth at 39-40 weeks GA. These data are useful for planning timing of delivery, for counseling, and for risk adjustment in outcomes analyses.
Oral Contributions North, Room 121
Saturday, March 09, 2013, 8:15 a.m.-8:30 a.m.
Session Title: Congenital Cardiology Solutions: Pediatric
Abstract Category: 13. Congenital Cardiology Solutions: Pediatric
Presentation Number: 904-4
- 2013 American College of Cardiology Foundation