Outcomes in low birth weight and premature babies

Outcomes in low birth weight and premature babies with congenital heart disease Dr Leila Rittey Trust Doctor Paediatric Cardiology

Why did we do this project? • These patients can spend a long time in the neonatal units/ children’s wards • Complex patients requiring a lot of care • Paucity of data • To assist in advising families

Patient Population • Inclusion – less than 35/40 and/or birth weight less than 2. 5 kg - congenital heart disease - born between 1 st January 2014 – 31 st December 2016 and had any care at Leeds General Infirmary or Jessop Wing, Sheffield neonatal units • Exclusion – Simple PDA

Methodology • Badgernet search for patients who met criteria • Reviewed data on Badgernet, cardiac database and LGI patient database • Liased with paediatricians with expertise in cardiology and their secretaries to obtain local discharge dates and data about those patients receiving care locally not by visiting paediatric cardiologists

Results • 190 patients met criteria • 83 female, 106 male, 1 indeterminate sex • Associated genetic conditions: T 21=22, T 13=2, T 18=3, Treacher Collins=1 Noonans=1, Turners=1, Di. George=1, T 9 Mosaic=2, Trisomy X=1, Chromosome 2 deletion=1, Fetal alcohol=1

Mortality • • 56/190 (29. 5%) died 38 (68%) before intervention 18 (32%) following a cardiac procedure Majority (80%) of infants death occurred after a planned withdrawal or an untreatable non-cardiac illness The most significant risk factor for mortality was the presence of chromosomal anomalies (p<0. 05). Huge burden of co-morbidity - 95% displaying at least 1 other significant non-cardiac system disorder (median 2, range 0 -4) Although the group who died were smaller than the survivors (mean 1780 g vs 1900) this did not meet statistical significance. There was no difference in gestational age

Results cont • 32 (17%) patients are no longer under cardiac follow up due to lesion spontaneously resolving • 81 (43%) patients have had at least 1 intervention

Conclusions • These patients are at a significant risk of mortality (30%) mainly due to non-cardiac reasons • Some of the patients that do survive require very long stays in hospital • There is a significant level of comorbidity • By sharing this information with parents we can help them prepare • Many of the small ASD’s/VSD’s close spontaneously with no need for intervention

Acknowledgments • Dr Thomson – Supervisor • Dr Bustani and Dr Ravindran – Neonatal consultant support • Paediatricians with expertise in cardiology and their secretaries from the region (and beyond) in particular Dr Talekar • Mr Kevin Wilby – Cardiac database manager • Mr Mal Thomas – Badgernet database lead LGI • The Children’s Heart Surgery Fund

Any Questions? ?