Congenital Heart Disease In Infants Research Articles

Necrotizing enterocolitis in term infants with congenital heart disease and preterm infants after surgery

Background: The purpose of this study was to report and compare the surgical outcomes of preterm-related necrotizing enterocolitis (PNEC) and congenital heart disease (CHD)-related necrotizing enterocolitis (CDNEC). Materials and Methods: Preterm infants without CHD and term infants with CHD who developed NEC and needed surgery were included in this cohort study between 2018 and 2021 at our university-affiliated hospital. A board-certified pediatric cardiologist examined all the patients with echocardiographic and cardiac examinations to diagnose CHD, and a pediatric surgeon evaluated the neonates for surgical indications. Patient characteristics, pregnancy history, and surgical and mortality outcomes were collected from the infants’ medical records. Results: Forty infants with NEC were included. The CDNEC and PNEC groups consisted of 18 and 22 infants, respectively. Although the disease-specific mortality rate was higher in the CDNEC group than in the PNEC group, the difference was insignificant (55.5% and 40.9%, respectively, P=0.36). There was no statistically significant difference in the time of NEC occurrence, location, type of surgery, or indications for surgery between the two groups. Conclusion: Despite the pathophysiologies of CDNEC and PNEC being different, the characteristics, pregnancy history, surgical, and mortality outcomes of these two types are similar in infants who undergo surgical treatment.

Recurrent acute kidney injury is associated with delayed language development in infants with Congenital Heart Disease.

Neurodevelopmental delay is common in children who undergo surgery for Congenital Heart Disease (CHD) in infancy. Cardiac surgery associated acute kidney injury (CS-AKI) occurs frequently in the paediatric cardiac Intensive care unit (ICU). Cardiac surgery associated acute kidney injury (CS-AKI) is associated with worse neurodevelopmental scores and delay in cognitive, language, and motor domains in children with CHD. No known data exist regarding the association of CS-AKI and motor and language subscales. In this study, we explored the relationship between CS-AKI and receptive and expressive language, as well as gross and fine motor delay. This was a single centre retrospective observational cohort study. Children who underwent surgery for CHD and developed recurrent CS-AKI in the first year of life who had follow-up neurodevelopmental testing using the Bayley Scale of Infant Development Version III were included. Neurodevelopmental delay subscales assessed included: receptive and expressive language, fine and motor skills. The study cohort included 203 children. Recurrent CS-AKI was significantly associated with lower scores in receptive and expressive language, as well as fine and gross motor on unadjusted analyses. On adjusted analyses, recurrent CS-AKI was significantly associated with severe receptive language delay. The independent association of recurrent CS-AKI with severe language delay in children who undergo surgery for CHD in infancy is novel. Our findings may contribute to the understanding of language impairment in this population. Further studies are required to better understand this relationship and any potentially modifiable factors.

Congenital Anomalies of the Gastrointestinal Tract inConjunction of Congenital Heart Diseases in Infants With Trisomy 21.

Infants with Trisomy 21 are known to have increased incidence congenital anomalies including congenital heart diseases (CHD) and congenital gastrointestinal anomalies. It is not known if there are patterns of coexistence. To examine the coexistence of CHD with various gastrointestinal anomalies in infants with Trisomy 21. We assessed a sample of infants with Trisomy 21 from the National Inpatient Sample (NIS), and its KID subversion, produced by the Healthcare Cost and Utilization Project for 2003-2015. We identified CHD using international classification of diseases version 9 (ICD9) and categorized them into four groups: left sided lesions, right sided lesions, conotruncal lesions, and shunt lesions. We identified small intestinal atresia and Hirschsprung disease with ICD9 codes. The sample included 81,561 newborn infants diagnosed with Trisomy 21; 45% of them had CHD; 4.7% had small intestinal atresia, and 1.6% had Hirschsprung disease. All subcategories of CHD were associated with increased incidence of both small intestinal atresia and Hirschsprung disease, p value < 0.05 compared to infants with Trisomy 21 who did not have CHD. Among infants with Trisomy 21, the presence of CHD increased the odds of a concomitant congenital GI anomaly.

Validation of a Paralimbic-Related Subcortical Brain Dysmaturation MRI Score in Infants with Congenital Heart Disease.

Background: Brain magnetic resonance imaging (MRI) of infants with congenital heart disease (CHD) shows brain immaturity assessed via a cortical-based semi-quantitative score. Our primary aim was to develop an infant paralimbic-related subcortical-based semi-quantitative dysmaturation score, termed brain dysplasia score (BDS), to detect abnormalities in CHD infants compared to healthy controls and secondarily to predict clinical outcomes. We also validated our BDS in a preclinical mouse model of hypoplastic left heart syndrome. Methods: A paralimbic-related subcortical BDS, derived from structural MRIs of infants with CHD, was compared to healthy controls and correlated with clinical risk factors, regional cerebral volumes, feeding, and 18-month neurodevelopmental outcomes. The BDS was validated in a known CHD mouse model named Ohia with two disease-causing genes, Sap130 and Pchda9. To relate clinical findings, RNA-Seq was completed on Ohia animals. Findings: BDS showed high incidence of paralimbic-related subcortical abnormalities (including olfactory, cerebellar, and hippocampal abnormalities) in CHD infants (n = 215) compared to healthy controls (n = 92). BDS correlated with reduced cortical maturation, developmental delay, poor language and feeding outcomes, and increased length of stay. Ohia animals (n = 63) showed similar BDS findings, and RNA-Seq analysis showed altered neurodevelopmental and feeding pathways. Sap130 mutants correlated with a more severe BDS, whereas Pcdha9 correlated with a milder phenotype. Conclusions: Our BDS is sensitive to dysmaturational differences between CHD and healthy controls and predictive of poor outcomes. A similar spectrum of paralimbic and subcortical abnormalities exists between human and Ohia mutants, suggesting a common genetic mechanistic etiology.

Microbiome and Growth in Infants with Congenital Heart Disease

ObjectivesTo profile the gut microbiome in infants with congenital heart disease undergoing cardiac surgery compared with matched infants and to investigate the association with growth (weight, length, and head circumference). Study designA prospective study in the Cardiac Intensive Care Unit at Children’s Healthcare of Atlanta and newborn nursery within the Emory Healthcare system. Characteristics including weight, length, head circumference, and surgical variables were collected. Fecal samples were collected pre-surgery (T1), post-surgery (T2), and before discharge (T3), and once for controls. 16S rRNA V4 gene was sequenced from fecal samples and classified into taxonomy using Silva v138. ResultsThere were 34 children with congenital heart disease (cases) and 34 controls. Cases had higher alpha-diversity, and beta-diversity showed significant dissimilarities compared with controls. Gut microbiome was associated with lower weight and smaller head circumference (z-score <2). Lower weight was associated with less Acinetobacter, Clostridioides, Parabacteroides, and Escherichia-Shigella. Smaller head circumference with more Veillonella, less Acinetobacter, and less Parabacteroides. ConclusionsSignificant differences in gut microbiome diversity and abundance were observed between infants with congenital heart disease and control infants. Lower weight and smaller head circumference were associated with distinct gut microbiome patterns. Further study is needed to understand the longitudinal effect of microbial dysbiosis on growth in children with congenital heart disease.

Using Cloud Healthcare to Improve Home Learning Efficacy in Congenital Heart Disease Infants

During the COVID-19 pandemic, visitation restrictions in line with infection control policies curtailed opportunities for family members to learn essential caregiving skills in the intensive care unit. This limitation decreased satisfaction among family members, possibly indicating their increased difficulties in care due to the lack of face-to-face guidance. Thus, increasing family member understanding of and ability to apply learning content without direct interaction presents a significant and urgent challenge. Moreover, because of lack of caregiving confidence, some family members may be reluctant to facilitate the discharge of critically ill patients, causing delays in discharge planning. These challenges underscore the obstacles faced by nursing health education during the pandemic. This study was designed to utilize cloud technology to enhance the knowledge and skills of families caring for infants with congenital heart disease at home and to assess their satisfaction with the associated homecare learning platform. Based on our hospital's cloud-based health education platform, a series of personalized instructional video materials was developed for families of infants with congenital heart disease. These materials cover comprehensively the entire treatment process, from diagnosis to post-discharge home care skills, for these patients. To facilitate autonomous learning, the videos in this series were made accessible to the families anytime, anywhere via personal devices such as smartphones and tablets. Concurrently, a chatbot tool was integrated to provide guidance on inpatient care for infants with congenital heart disease, including fundamental aspects of newborn care, with the aim of equipping parents and caregivers with the knowledge and skills necessary to provide basic post-discharge care. To ensure the families acquired personalized care skills, after completing the learning modules, practical bedside training sessions incorporating knowledge and skills assessments were organized for family members. After project implementation, the average knowledge score for family members increased significantly from 79.1 to 100 (perfect score). The proportion of family members proficient in executing caregiving techniques autonomously also rose impressively from 30% to 95%. Furthermore, average overall satisfaction with cloud-based technology-assisted caregiving learning among the family members rose 31.4% from 3.5 to 4.6. This project represents a viable solution to providing clinical nursing guidance independent of the constraints of time and location, and effectively enhances homecare-skill-related learning outcomes in family members, especially with regard to caring for infants with congenital heart disease.

Clinical Decision Analysis of Genetic Evaluation and Testing in 1013 Intensive Care Unit Infants with Congenital Heart Defects Supports Universal Genetic Testing.

Extracardiac anomalies (ECAs) are strong predictors of genetic disorders in infants with congenital heart disease (CHD), but there are no prior studies assessing performance of ECA status as a screen for genetic diagnoses in CHD patients. This retrospective cohort study assessed this in our comprehensive inpatient CHD genetics service focusing on neonates and infants admitted to the intensive care unit (ICU). The performance and diagnostic utility of using ECA status to screen for genetic disorders was assessed using decision curve analysis, a statistical tool to assess clinical utility, determining the threshold of phenotypic screening by ECA versus a Test-All approach. Over 24% of infants had genetic diagnoses identified (n = 244/1013), and ECA-positive status indicated a 4-fold increased risk of having a genetic disorder. However, ECA status had low-moderate screening performance based on predictive summary index, a compositive measure of positive and negative predictive values. For those with genetic diagnoses, nearly one-third (32%, 78/244) were ECA-negative but had cytogenetic and/or monogenic disorders identified by genetic testing. Thus, if the presence of multiple congenital anomalies is the phenotypic driver to initiate genetic testing, 13.4% (78/580) of infants with isolated CHD with identifiable genetic causes will be missed. Given the prevalence of genetic disorders and limited screening performance of ECA status, this analysis supports genetic testing in all CHD infants in intensive care settings rather than screening based on ECA.

Dual dilemma: Necrotizing enterocolitis and congenital heart disease in infants.

Dual dilemma: Necrotizing enterocolitis and congenital heart disease in infants.

Risk Factors of Chylothorax After Congenital Heart Surgery in Infants: A Single-Centre Retrospective Study.

Studies of chylothorax after congenital heart disease in infants are rare. Chylothorax has a higher incidence in infancy, but its risk factors are not well understood. The purpose of this study is to investigate the risk factors of chylothorax after congenital heart surgery in infants. This retrospective study included 176 infants who underwent congenital heart disease surgery at the Guangdong Cardiovascular Institute, China, between 2016 and 2020. According to the occurrence of chylothorax, the patients were divided into a control group (n = 88) and a case group (n = 88). Univariate and multivariate logistic regression were performed to analyse the incidence and influencing factors of chylothorax after congenital heart surgery in infants. Between 2016 and 2020, the annual incidence rate fluctuated between 1.55% and 3.17%, and the total incidence of chylothorax was 2.02%. Multivariate logistic regression analysis showed that postoperative albumin (p = 0.041; odds ratio [OR] = 0.095), preoperative mechanical ventilation (p = 0.001; OR = 1.053) and preterm birth (p = 0.002; OR = 5.783) were risk factors for postoperative chylothorax in infants with congenital heart disease. The total incidence of chylothorax was 2.02% and the annual incidence rate fluctuated between 1.55% and 3.17% between 2016 and 2020. Premature infants, longer preoperative mechanical ventilation and lower albumin after congenital heart surgery may be risk factors for chylothorax. In addition, infants with chylothorax are inclined to be infected, need more respiratory support, use a chest drainage tube for longer and remain longer in hospital.

Impact of Congenital Heart Disease on the Outcomes of Very Low Birth Weight Infants.

This study aimed to investigate the association of congenital heart disease (CHD) with morbidity and mortality of very low birth weight (VLBW) infants. This matched case-control study included VLBW infants born at a single institution between 2001 and 2015. The primary outcome was mortality. Secondary outcomes included necrotizing enterocolitis, bronchopulmonary dysplasia (BPD), sepsis, retinopathy of prematurity, and intraventricular hemorrhage. These outcomes were assessed by comparing VLBW-CHDs with control VLBW infants matched by gestational age within a week, birth weight within 500 g, sex, and birth date within a year using conditional logistic regression. Multivariable logistic regression analyzed differences in outcomes in the VLBW-CHD group between two birth periods (2001-2008 and 2009-2015) to account for changes in practice. In a cohort of 44 CHD infants matched with 88 controls, the mortality rate was 27% in infants with CHD and 1% in controls (p < 0.0001). The VLBW-CHDs had increased BPD; (odds ratio [OR]: 7.70, 95% confidence interval [CI]: 1.96-30.29) and sepsis (OR: 10.59, 95% CI: 2.99-37.57) compared with the control VLBWs. When adjusted for preoperative ventilator use, the VLBW-CHDs still had significantly higher odds of BPD (OR: 6.97, 95% CI: 1.73-28.04). VLBW-CHDs also had significantly higher odds of both presumed and culture-positive sepsis as well as late-onset sepsis than their matched controls. There were no significant differences in outcomes between the two birth periods. VLBW-CHDs showed higher odds of BPD, sepsis, and mortality than VLBW infants without CHD. Future research should focus on the increased mortality and specific complications encountered by VLBW infants with CHD and implement targeted strategies to address these risks. · Incidence of CHD is higher in preterm infants than in term infants but the incidence of their morbidities is not well described.. · VLBW infants with CHD have higher odds of mortality, bronchopulmonary dysplasia, and sepsis.. · Future research is needed to implement targeted preventive responses..

891 Maternal risk factor clusters and risk of infant congenital heart disease and maternal morbidity

891 Maternal risk factor clusters and risk of infant congenital heart disease and maternal morbidity

Investigating the Risk Factors of Congenital Heart Diseases in Newborns Admitted to Amir al-Momenin Hospital in Semnan from 2020-2021

Introduction: Congenital heart defects refer to conditions that affect the structure and function of a newborn’s heart. The aim of this study was to investigate the prevalence and risk factors of congenital heart diseases in hospitalized infants in the neonatal intensive care unit of Amiralmomenin Hospital in Semnan. Methods: In this study, 300 medical records of hospitalized infants who underwent echocardiography in the neonatal intensive care unit of Amiralmomenin Hospital in Semnan during 2020-2021 were reviewed. The overall prevalence of congenital heart diseases and their types (ASD/VSD/PDA/TOF) were determined, and the association of study variables (infant gender, gestational age, maternal age, infant weight, parental family history, medication use during pregnancy, and history of heart disease and gestational diabetes) with congenital heart disease was evaluated. Results: The results showed that out of the total 300 hospitalized infants who underwent echocardiography, 132 infants (44%) were diagnosed with congenital heart disease. PDA and VSD were the most common types of congenital heart diseases with a prevalence of 8.56% and 5.23%, respectively. Conclusion: According to the results, there was a significant association between congenital heart disease and diabetes, hypertension, as well as medication use during pregnancy and family history of heart disease , infant gender, gestational age, and weight did not show a significant association. However, there was a significant association between the type of congenital heart disease and gestational age and infant weight, with an increase in gestational age and infant weight leading to a decrease in the prevalence of congenital heart disease

Infant congenital heart disease prevalence and mortality in French Guiana: a population-based study

Few studies have assessed the prevalence and mortality of simple or complex congenital heart diseases (CHD) in newborns. In Latin America and Caribbean (LAC), CHD epidemiology seems highly variable, with few population-based assessments and different methodologies between studies. To date, the situation in French Guiana, a French overseas territory located in South America between Brazil and Suriname, has never been described. We analysed CHD prevalence, characteristics and related infant mortality in French Guiana, with a population-based registry analysis of all fetal and live birth CHD cases in infants under 1 year (January 2012-December 2016). Overall, 33,796 births (32,975 live births) were registered, with 231 CHD (56 fetuses), including 215 live births. Most frequent CHD categories were anomalies of the ventricular outflow tract and extra-pericardial trunks, and ventricular septal defects. 18.6% (43/231) chromosomal or genetic anomalies, and 6.5% (15/231) terminations of pregnancy were observed. Total CHD prevalence was 68.4 [95% CI: 67.9-68.8] per 10,000, while live birth prevalence was 65.2 [95% CI: 64.7-65.7] per 10,000. Total infant mortality was 9.4/10,000 live births [95% CI 9.1-9.7], with highest rates for functionally univentricular hearts (FUH). A distinct profile for CHD is highlighted in French Guiana with elevated mortality linked to FUH. A potential determinant of the recognized excess mortality risk might be the presence of chromosomal or genetic anomalies in about a fifth of all CHD. This helps us to better understand CHD burden in this part of South America and provides future keys towards reducing CHD-related infant mortality. The authors received no financial support for the present research, authorship, and/or publication of this article.

Can perioperative electroencephalogram and adverse hemodynamic events predict neurodevelopmental outcomes in infants with congenital heart disease?

ObjectiveThe study objective was to characterize preoperative and postoperative continuous electroencephalogram metrics and hemodynamic adverse events as predictors of neurodevelopment in congenital heart disease infants undergoing cardiac surgery. MethodsFrom 2010 to 2021, 320 infants underwent congenital heart disease surgery at our institution, of whom 217 had perioperative continuous electroencephalogram monitoring and were included in our study. Neurodevelopment was assessed in 76 patients by the Bayley Scales of Infant and Toddler Development, 3rd edition, consisting of cognitive, communication, and motor scaled scores. Patient and procedural factors, including hemodynamic adverse events, were included by means of the likelihood of covariate selection in our predictive model. Median (25th, 75th percentile) follow-up was 1.03 (0.09, 3.44) years with 3 (1, 6) Bayley Scales of Infant and Toddler Development, 3rd Edition evaluations per patient. ResultsMedian age at index surgery was 7 (4, 23) days, and 81 (37%) were female. Epileptiform discharges, encephalopathy, and abnormality (lethargy and coma) were more prevalent on postoperative continuous electroencephalograms, compared with preoperative continuous electroencephalograms (P < .005). In 76 patients with Bayley Scales of Infant and Toddler Development, 3rd edition evaluations, patients with diffuse abnormality (P = .009), waveform discontinuity (P = .007), and lack of continuity (P = .037) on preoperative continuous electroencephalogram had lower cognitive scores. Patients with synchrony (P < .005) on preoperative and waveform continuity (P = .009) on postoperative continuous electroencephalogram had higher fine motor scores. Patients with postoperative adverse events had lower cognitive (P < .005) and gross motor scores (P < .005). ConclusionsPhenotypic patterns of perioperative continuous electroencephalogram metrics are associated with late-term neurologic injury in infants with congenital heart disease requiring surgery. Continuous electroencephalogram metrics can be integrated with hemodynamic adverse events in a predictive algorithm for neurologic impairment.

Abstract 17043: Role of Child Opportunity Index on Neonatal Mortality and 1-Year Mortality in Infant Congenital Heart Disease: A Contemporary Population-Based Report

Introduction: Although mortality has declined among infants with congenital heart disease (CHD), racial/ethnic and sociodemographic disparities persist. The child opportunity index (COI) is a census-based metric of neighborhood conditions based on education, health/environment, and social/economic domains. We sought to determine the impact of COI on neonatal and 1-year mortality of infants with CHD. Hypothesis: We hypothesized that neighborhood sociodemographic factors as measured by COI would have a greater impact on longer-term outcomes. Methods: This is a retrospective population-based cohort in California (2011-2017) of infants with CHD who underwent a cardiac intervention in the first year of life. COI was categorized into high, moderate, and low. Each COI domain was evaluated. The primary outcomes included 1-year mortality, neonatal mortality prior to 30 days of life, and days alive out of hospital in the first year of life (DAOOH). Uni- and multivariable logistic and linear regression were used. Results: The sample included 9,729 infants with an overall 1-year mortality rate of 8.2% and neonatal mortality rate of 3.5%. After adjusting for race/ethnicity, maternal age, sex, CHD severity (RACHS-1 category), birth weight z-score, and gestational age at birth, the odds of 1-year mortality were significantly higher among infants from low compared to high COI (1.37, 95%CI: 1.13, 1.67). In contrast, the adjusted odds of neonatal mortality were not different in low compared to high COI (1.20, 95%CI:0.89,1.61). Low and moderate COI groups had significantly lower DAOOH compared to high COI (low: -10.30, 95%CI: -15.2, -5.4; moderate: -7.43, 95%CI: -12.96, -1.89). Results were similar for each COI domain ( Figure 1). Conclusion: Neighborhood factors reflecting the home environment influence outcomes beyond the neonatal period. Future studies are needed to determine whether targeting domains of the COI will mitigate ongoing risks of poor CHD outcomes.

Sociodemographic profile associated with congenital heart disease among infants

PurposeCongenital heart disease affects thousands of newborns each year in the United States. Previous United States-based research has explored how sociodemographic factors may impact health outcomes in infants with congenital heart disease; however, their impact on the incidence of congenital heart disease is unclear. We explored the sociodemographic profile related to congenital heart disease to help address health disparities that arise from race and social determinants of health. Defining the sociodemographic factors associated with congenital heart disease will encourage implementation of potential preventative measures. Design and methodsWe conducted a secondary analysis of longitudinally collected data comparing 39 infants with congenital heart disease and 30 healthy controls. We used a questionnaire to collect sociodemographic data. Pearson's chi-square test/Fisher's exact tests analyzed the associations among different sociodemographic factors between infants with congenital heart disease and healthy controls. ResultsWe found a statistically significant difference in maternal education between our 2 groups of infants (p = 0.004). ConclusionMaternal education was associated with congenital heart disease. Future studies are needed to further characterize sociodemographic factors that may predict and impact the incidence of congenital heart disease and to determine possible interventions that may help decrease health disparities regarding the incidence of congenital heart disease. Practice implicationsUnderstanding the associations between maternal sociodemographic factors and infant congenital heart disease would allow clinicians to identify mothers at higher risk of having an infant with congenital heart disease.

Analysis of the Use of Non-Invasive Lung Ventilation Support in Newborns and Young Children after Cardiac Surgery

Background. Non-invasive ventilatory support for artificial lung ventilation (ALV) in infants with congenital heart disease after cardiac surgery helps to reduce the duration of invasive ALV, reduce the number of mechanical and infectious complications, and reduce or eliminate the need for sedation.&#x0D; The aim. To analyze the experience of using non-invasive ventilatory support after surgical correction of congenital heart disease in infants and compare its effectiveness with invasive mechanical ventilation.&#x0D; Materials and methods. We conducted a retrospective analysis of the use of non-invasive ALV and its effectiveness compared to invasive mechanical ventilation in children under 1 year of age after cardiac surgery from 2020 to 2022 at the Department of Cardiac Arrest in Newborns and Young Children of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. During this period, 134 patients were operated on (38 children under 1 month old, 96 children under 1 year old). In the postoperative period, 85 children (55.9%) needed prolonged mechanical ventilation (more than 24 hours), of which non-invasive ventilation support was used in 32 patients (37.6%) and invasive ventilation in 53 (62.3%) patients.&#x0D; Results. The patients on non-invasive ALV (n = 32) had lower weight (p = 0.23), shorter ventilation time (p = 0.56), and the time spent at the intensive care unit (p = 0.61), required less sedation (p = 0.29), and had lower mortality (p = 0.42) compared to the group of children who received only invasive ventilatory support (n = 53), but this difference was not statistically significant. The need for non-invasive ventilation was higher in 9 (28.12%) infants than in 8 (15.09%) other infants and was statistically significant (p &lt; 0.001).&#x0D; Conclusions. Our study showed that the use of non-invasive ALV can shorten the length of stay at the intensive care unit and the time spent on ventilation, reduce or avoid the use of sedation, and prevent pulmonary complications (infectious and mechanical) with long-term treatment. However, there was no significant difference between non-invasive and invasive ventilation in terms of mortality.

Social inequities impact infant mortality due to congenital heart disease

ObjectivesTo evaluate how educational, economic, and racial residential segregation may impact congenital heart disease infant mortality (CHD-IM). Study designThis is a population-based US ecological study. MethodsThis study evaluated linked live birth-infant death files from the National Center for Health Statistics for live births from 2006 to 2018 with cause of death attributed to CHD. Maternal race and education data were obtained from the live birth-infant death files, and income data were obtained from the American Community Survey. A spatial social polarization measure termed the Index of Concentration at the Extremes (ICE) was calculated and split by quintiles for maternal education, household income, and race for all US counties (n = 3142). The lowest quintile represents counties with highest concentration of disadvantaged groups (income < $25K, non-Hispanic Black, no high school degree). Proximity to a pediatric cardiac center (PCC) was also analyzed in a categorical manner based on whether each county was in a metropolitan area with a US News and World Report top 50 ranked PCC, a lower ranked PCC, or not proximal to any PCC. ResultsBetween 2006 and 2018, 17,489 infant deaths were due to CHD, an unadjusted CHD-IM of 0.33 deaths per 1000 live births. The risk of CHD-IM was 1.5 times greater among those in the lowest ICE-education quintile (0.41 [0.39–0.44] vs 0.28 deaths/1000 live births [0.27–0.29], P < 0.0001) and the lowest ICE-income quintile (0.44 [0.41–0.47] vs 0.29 [0.28–0.30], P < 0.0001) in comparison to those in the highest quintiles. CHD-IM increases with higher ICE-race value (counties with a higher concentration of non-Hispanic White mothers). However, after adjusting for proximity to a US News and World Report top 50 ranked PCC in the multivariable models, CHD-IM decreases with higher ICE-race value. ConclusionsCounties with the highest concentration of lower-educated mothers and the highest concentration of low-income households were associated with higher rates of CHD-IM. Mortality as a function of race is more complicated and requires further investigation.

A systematic review of early motor interventions for infants with congenital heart disease and open-heart surgery

BackgroundMotor development delay is the first neurodevelopmental impairment that becomes apparent in infants with congenital heart disease (CHD). Early interventions have addressed high-risk groups like infants born preterm, but little is known about interventions to improve motor outcome in CHD infants at risk of motor delay. The purpose of this review was to systematically review the literature on type and effect of motor intervention applied during the first year of life in infants with CHD following open-heart surgery.MethodsScoping searches were performed in May 2020 and April 2023 via MEDLINE, Embase, CINAHL, Cochrane, PsycINFO, PEDro, and Scopus. The review included studies published in English from 2015 to 2022. Primary outcome was infants’ motor development measured by standardized and non-standardized motor assessments, and if available, infants’ language and cognitive development, and any parental quality-of-life assessments as secondary outcomes. The studies’ quality was evaluated with a modified Newcastle-Ottawa scale.ResultsFour papers with low to high methodological quality met inclusion criteria. All studies investigated the influence of early physiotherapy. Four studies involved parents, and three studies used standardized tools to assess motor outcomes. No conclusion can be drawn about any positive effect of early motor interventions.ConclusionsEarly motor intervention in CHD infants may improve motor development; however, the few existing studies do not provide clear evidence. Thus, more prospective early intervention studies are needed.Trial registrationPROSPERO CRD42020200981.

Should We Monitor Renal Functions in Congenital Heart Disease Infants Using High Energy Infant Formula? A Case Report

Background High Energy Infant Formula (HEIF) promotes adequate catch-up growth in infants with faltering growth. Of concern, is the potential increased risk of HEIF as a high protein diet on renal function. Case Presentation This four month old female presented with ventricular septal defect, pulmonary hypertension and heart failure that was controlled with treatment. She suffered from faltering growth where her weight and length were &amp;lt; -2 z-score for age thus HEIF was prescribed. Serum creatinine was high normal. Two weeks after HEIF intake, growth was still faltering and mild dyspnea reappeared inspite cardiac medications. Investigations showed a rising high serum creatinine. Abdominal ultrasound revealed the presence of a single kidney. The exact contribution of predisposing factors to renal dysfunction can’t be measured since the patient had an already borderline renal functions. Conclusion Renal functions should be monitored before HEIF and during its use to avoid renal dysfunction in susceptible patients.