(57) Personalized Outcome Predictions for Patients with Congenital Heart Disease

Background: Congenital heart disease (CHD) is the most common birth defect and contributes significantly to infant morbidity and mortality. There are several factors that have been reported to affect postnatal outcomes. However, there has not been a comprehensive evaluation of all significant factors nor a method for aggregating those factors to provide a more precise prediction of neonatal outcomes in infants with symptomatic CHD.

Objectives: The objective of this study was to determine which maternal factors and fetal/neonatal characteristics can better predict postnatal outcomes for infants born with symptomatic CHD.

Design/Methods: A retrospective cohort study was conducted among neonates with CHD who were admitted to the Riley CVICU/Heart Center and/or Level IV NICU between 2021 and 2023. Maternal and fetal characteristics obtained include medical and demographic data, genetic testing, echocardiographic findings, home healthcare needs, length of hospital stay, NICU and infant survival, surgical interventions, and readmissions during the 1st year of life. Statistical analysis including bivariate logistic regression analysis was performed to determine which factors were associated with outcomes of longer length of stay, mortality, and cardiac surgery within the first admission after birth.

Results: There were 196 infants who met inclusion criteria, of which there were 32 (16%) deaths, and 135 (69%) who had cardiac surgery within the first admission. The average length of stay was 75 ± 88 days. The factors that were significantly associated with cardiac surgery during the NICU stay include gestational hypertension, tobacco use during pregnancy, the presence of non-cardiac anomalies, any genetic diagnosis, and patient requiring mechanical ventilation. Mode of delivery, birth weight, the presence of non-cardiac anomalies and any genetic diagnosis were significantly associated with mortality during the NICU admission. Race, pre-eclampsia, mode of delivery, any genetic diagnosis and need for mechanical ventilation were significantly associated with longer length of stay.

Conclusion: There were several prenatal and neonatal factors that were associated with early cardiac surgery, NICU mortality, and longer length of stay. The presence of any genetic diagnosis was predictive of all three outcomes of interest. The factors identified as being significant predictors of 1-year outcomes can help to create predictive models and better counsel families regarding the medical needs and range of outcomes for their child.