267 - Intraventricular Hemorrhage and Retinopathy of Prematurity in Preterm Infants with Congenital Heart Disease

Publication Number: 4263.267

Srirupa Hari Gopal, Saint Louis University School of Medicine, St Louis, MO, United States; Ryan Kilpatrick, Tufts University School of Medicine, Winchester, MA, United States; Rachel G. Greenberg, Duke Clinical Research Institute, Durham, NC, United States; Henry Foote, Duke University School of Medicine, Durham, NC, United States; Veeral Tolia, Pediatrix, Dallas, TX, United States; Lakshmi Katakam, Duke University School of Medicine, Durham, NC, United States

Background: Preterm infants with congenital heart disease (CHD) are a unique population whose outcomes have not been studied extensively. The incidence of intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP) in preterm infants with CHD remains unknown, though risk may be increased by both prematurity and CHD.

Objective: This study aims to determine the incidence of and risk factors for IVH and ROP among preterm infants with CHD.

Design/Methods: Observational cohort study of infants born 22 - 36 weeks gestational age (GA) and discharged between 2014 - 2023 from >300 NICUs from the Pediatrix Medical Group. CHD was defined as structural heart disease at birth excluding isolated patent ductus arteriosus, ventricular or atrial septal defect/patent foramen ovale. We excluded infants who died postnatal day 0 or 1, and infants who were transferred prior to discharge. Descriptive statistics were used to identify incidence of severe IVH and ROP. Categorical variables were reported as frequencies and percentages, continuous variables as medians with interquartile ranges. Demographics and clinical characteristics between infants with CHD versus infants without CHD were compared using Kruskal-Wallis or Chi-squared tests. Two multivariable logistic regression models were used to assess the association between CHD and severe IVH and severe ROP among infants with at least one head ultrasound or ROP exam, respectively. Multivariable analysis adjusted for GA group, small for gestational age (SGA) status, early onset sepsis, duration of mechanical ventilation, duration of supplemental oxygen, and receipt of prostaglandin E1 (PGE1), inotropes, postnatal indomethacin, and antenatal steroids.

Results: Infants with CHD had a higher rate of severe IVH and ROP at most gestational ages (Figure 1). In comparison to preterm infants without CHD, preterm infants with CHD were of lower gestational age, required longer duration of mechanical ventilation and supplemental oxygen, and were more likely to receive PGE1, inotropes, inhaled nitric oxide, indomethacin, steroids and anticoagulation. They also had higher incidences of severe IVH, severe ROP, bronchopulmonary dysplasia, NEC, SIP, PVL, late onset sepsis, ECMO, and death (Table 1). When adjusted for confounders, preterm infants with CHD had higher odds of severe IVH (aOR 1.35, 95% CI 1.10-1.66), but not severe ROP (aOR 1.27, 95% CI 0.98-1.65) [Table 2].

Conclusion(s): Preterm infants with CHD experience a higher incidence of morbidities related to prematurity. CHD is independently associated with severe IVH. Infants with CHD may require increased surveillance for IVH.

Figure 1: Incidence of severe IVH (A) and severe ROP (B) among preterm infants with and without congenital heart disease (CHD), stratified by gestational age (in weeks).


Table 1: Characteristics and outcomes of preterm infants with and without CHD.


Table 2: Multivariable logistic regression analyses of risk factors associated with severe IVH or severe ROP among preterm infants with at least one head ultrasound or ROP exam, respectively.
Small for gestational age (SGA): Infant with weight less than or equal to 10th percentile for gestational age by Olsen criteria.
Early Onset Sepsis (EOS): Defined as positive blood or CSF culture obtained postnatal day 0, 1, or 2.
Severe ROP: ROP Stage 3, 4, or 5. ROP severity was defined as the worst stage by International Classification of Retinopathy of Prematurity (ICROP) diagnosed on examination in the eye with the most advanced stage. ROP stages (from least to most severe) include the following: stage 0 = immature retinal vascularization, no ROP; stage 1 = presence of a demarcation line between vascular and avascular retina; stage 2 = presence of an elevated ridge at the vascular or avascular junction; stage 3 = extraretinal fibrovascular proliferation extending from the ridge; stage 4 = partial retinal detachment; and stage 5 = total retinal detachment.
Severe IVH: Defined as infant diagnosed with grade 3 or 4 periventricular-intraventricular hemorrhage (PIH) during birth hospitalization.