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Premature congenital heart disease: building a comprehensive database to evaluate risks and guide intervention

2020; Elsevier BV; Volume: 230; Linguagem: Inglês

10.1016/j.jpeds.2020.11.056

1097-6833

Paulomi Chaudhry, Molly K. Ball, Shannon E. G. Hamrick, Philip T. Levy, Jeanette Asselin, Beverly Brozanski, David J. Durand, Francine Dykes, Jacquelyn Evans, Theresa R. Grover, Karna Murthy, Michael Padula, Eugenia K. Pallotto, Anthony J. Piazza, Kristina M. Reber, Billie Lou Short,

Cardiovascular Issues in Pregnancy

We read with interest the report by Matthiesen et al.1Matthiesen N.B. Østergaard J.R. Hjortdal V.E. Henriksen T.B. Congenital heart defects and the risk of spontaneous preterm birth.J Pediatr. 2020; https://doi.org/10.1016/j.jpeds.2020.09.059Abstract Full Text Full Text PDF Scopus (2) Google Scholar This large population based study found a 2-fold increase in incidence of preterm birth in the setting of major congenital heart disease (CHD) and delineated specific subgroups of CHD with even higher adjusted risks (specifically, right ventricular outflow tract obstructions). This study fills a major gap of knowledge with respect to understanding the link between certain CHD lesions and the insults to the fetal environment, and highlights that little is known about the impact of perinatal risk factors on outcomes for this vulnerable preterm population. This is in part due to the recognition that no existing neonatal or cardiac focused database adequately collects the full spectrum of data points (eg, prenatal, perinatal, postnatal, and surgical) critical to perform outcomes research and identify best practices for the neonatal population with CHD. In addition, unique to preterm patients with CHD, postnatal care often requires transfer of patients between neonatal and cardiac units, further impeding comprehensive data collection. Recent studies have explored the link between maternal disorders and CHD,2Sanapo L. Donofrio M.T. Ahmadzia H.K. Gimovsky A.C. Mohamed M.A. The association of maternal hypertensive disorders with neonatal congenital heart disease: analysis of a United States cohort.J Perinatol. 2020; 40: 1617-1624Crossref PubMed Scopus (1) Google Scholar,3Auger N. Fraser W.D. Healy-Profitós J. Arbour L. Association between preeclampsia and congenital heart defects.JAMA. 2015; 314: 1588-1598Crossref PubMed Scopus (67) Google Scholar but the majority of contemporary postnatal evidence has focused on the negative associations between CHD mortality and gestational age at birth.4Norman M. Håkansson S. Kusuda S. Vento M. Lehtonen L. Reichman B. et al.Neonatal outcomes in very preterm infants with severe congenital heart defects: an international cohort study.J Am Heart Assoc. 2020; 9: e015369Crossref PubMed Scopus (4) Google Scholar, 5Steurer M.A. Baer R.J. Keller R.L. Oltman S. Chambers C.D. Norton M.E. et al.gestational age and outcomes in critical congenital heart disease.Pediatrics. 2017; 140: e20170999Crossref PubMed Scopus (29) Google Scholar, 6Yoon Y.M. Bae S.P. Kim Y.-J. Kwak J.G. Kim W.-H. Song M.K. et al.New modified version of the risk adjustment for congenital heart surgery category and mortality in premature infants with critical congenital heart disease.Clin Exp Pediatr. 2020; 63: 395-401Crossref PubMed Scopus (3) Google Scholar Despite advances in neonatal, cardiac, and cardiothoracic surgical management that continue to improve morbidity and mortality outcomes for premature infants with CHD, severe neonatal morbidities (eg, intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity, and bronchopulmonary dysplasia) still exist in this population, although true incidence of each varies between studies and by gestational age.4Norman M. Håkansson S. Kusuda S. Vento M. Lehtonen L. Reichman B. et al.Neonatal outcomes in very preterm infants with severe congenital heart defects: an international cohort study.J Am Heart Assoc. 2020; 9: e015369Crossref PubMed Scopus (4) Google Scholar, 5Steurer M.A. Baer R.J. Keller R.L. Oltman S. Chambers C.D. Norton M.E. et al.gestational age and outcomes in critical congenital heart disease.Pediatrics. 2017; 140: e20170999Crossref PubMed Scopus (29) Google Scholar, 6Yoon Y.M. Bae S.P. Kim Y.-J. Kwak J.G. Kim W.-H. Song M.K. et al.New modified version of the risk adjustment for congenital heart surgery category and mortality in premature infants with critical congenital heart disease.Clin Exp Pediatr. 2020; 63: 395-401Crossref PubMed Scopus (3) Google Scholar To fully understand the complex interplay between maternal factors, CHD, and prematurity, and to better identify specific prognostic factors for guiding therapeutic interventions and discerning outcomes, a multicenter neonatal-cardiac database that collects comprehensive prenatal, perinatal, and postnatal data throughout a hospital course is needed specifically for preterm CHD. We are indebted to the following institutions that serve the infants and their families, and these institutions also have invested in and continue to participate in the Children's Hospital's Neonatal Database (CHND). Jeanette Asselin, Beverly Brozanski, David Durand (ex officio), Francine Dykes (ex officio), Jacquelyn Evans (Executive Director), Theresa Grover, Karna Murthy (Chair), Michael Padula, Eugenia Pallotto, Anthony Piazza, Kristina Reber, and Billie Short are members of the Children's Hospitals Neonatal Consortium, Inc. For more information, please contact: [email protected] . The site sponsors/contributors for the CHND include: 1. AI DuPont Hospital for Children, Wilmington, DE (Kevin Sullivan) 2. All Children's Hospital, St. Petersburg, FL (Victor McKay) 3. American Family Children's Hospital, Madison, WI (Jamie Limjoco) 4. Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL (Karna Murthy, Gustave Falciglia) 5. Arkansas Children's Hospital, Little Rock, AR (Robert Lyle, Becky Rogers) 6. Brenner Children's Hospital, Winston Salem, NC (Cherie Welch) 7. Children's Healthcare of Atlanta, Atlanta, GA (Anthony Piazza) 8. Children's Hospital and Research Center Oakland, Oakland, CA (Priscilla Joe) 9. Children's Hospital Boston, Boston, MA (Anne Hansen) 10. Children's Hospital Colorado, Aurora, CO (Theresa Grover) 11. Children's Hospital of Alabama, Birmingham, AL (Carl Coghill) 12. Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA (Toby Yanowitz) 13. Children's Medical Center, Dallas, TX (Rashmin Savani,) 14. Children's Mercy Hospitals and Clinics, Kansas City, MO (Eugenia Pallotto) 15. Children's National Medical Center, Washington, DC (Billie Short, An Massaro) 16. Children's Healthcare of Atlanta at Scottish Rite (Gregory Sysyn) 17. Children's Hospital Los Angeles, Los Angeles, CA (Rachel Chapman) 18. Children's Hospital of Michigan, Detroit, MI (Girija Natarajan) 19. Children's Hospital of Omaha (Lynne Willett, Nicole Birge) 20. Children's Hospital of Wisconsin, Milwaukee, WI (Michael Uhing, Ankur Datta) 21. Children's Hospital Orange County, Los Angeles, CA (Michel Mikhael) 22. Cincinnati Children's Hospital, Cincinnati, OH (Beth Haberman) 23. Connecticut Children's Hospital, Hartford, CT (Annmarie Golioto) 24. Cook Children's Health Care System, Fort Worth, TX (Annie Chi, Yvette Johnson) 25. Florida Hospital for Children (Rajan Wadhawan) 26. Hospital for Sick Children, Toronto, ON (Kyong-Soon Lee) 27. Le Bonheur Children's Hospital, Memphis, TN (Ajay Talati) 28. Nationwide Children's Hospital, Columbus, OH (Kristina Reber) 29. Primary Children's Medical Center, Salt Lake City, UT (Con Yee Ling) 30. Rady Children's Hospital, San Diego, CA (Mark Speziale, Laurel Moyer) 31. Riley Children's Hospital, Indianapolis, IN (William Engle) 32. Seattle Children's Hospital, Seattle, WA (Elizabeth Jacobsen-Misbe, Robert 33. St. Christopher's Hospital for Children, Philadelphia, PA (Suzanne Touch) 34. St. Louis Children's Hospital, St Louis, MO (Rakesh Rao, Beverly Brozanski) 35. Texas Children's Hospital, Houston, TX (Gautham Suresh) 36. The Children's Hospital of Philadelphia, Philadelphia, PA (Michael Padula, David Munson) Congenital Heart Defects and the Risk of Spontaneous Preterm BirthThe Journal of PediatricsVol. 229PreviewTo estimate the association between major types of congenital heart defects (CHD) and spontaneous preterm birth, and to assess the potential underlying mechanisms. Full-Text PDF ReplyThe Journal of PediatricsVol. 230PreviewWe thank Chaudhry et al and the Children's Hospital Neonatal Consortium Cardiac Focus Group for the recognition and the interest in our recently published work. Moreover, we thank the authors for raising the important need for databases encompassing prenatal, neonatal, postnatal, and surgical data on patients with congenital heart defects. We agree that such databases are urgently needed to identify and stratify this patient population according to the risk of mortality and short-term complications such as neonatal morbidities, but also long-term complications such as neurodevelopmental disorders. Full-Text PDF