TY - JOUR
T1 - Perinatal and perioperative factors associated with mortality and an increased need for hospital care in infants with transposition of the great arteries
T2 - A nationwide 11-year population-based cohort
AU - Hautala, Johanna
AU - Gissler, Mika
AU - Ritvanen, Annukka
AU - Helle, Emmi
AU - Pihkala, Jaana
AU - Mattila, Ilkka P.
AU - Pätilä, Tommi
AU - Salminen, Jukka
AU - Puntila, Juha
AU - Jokinen, Eero
AU - Räsänen, Juha
AU - Vahlberg, Tero
AU - Ojala, Tiina
N1 - Publisher Copyright:
© 2020 Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). Published by John Wiley & Sons Ltd
PY - 2020/12
Y1 - 2020/12
N2 - Introduction: Newborn infants with transposition of the great arteries (d-TGA) need immediate care for an optimal outcome. This study comprised a nationwide 11-year population-based cohort of d-TGA infants, and assessed whether the implementation of a nationwide systematic fetal screening program, or other perinatal, or perioperative factors, are associated with mortality or an increased need for hospital care. Material and methods: The national cohort consisted of all live-born infants with simple d-TGA (TGA ± small ventricular septal defect, n = 127) born in Finland during 2004-2014. Data were collected from six national registries. Prenatal diagnosis and perinatal and perioperative factors associated with mortality and length of hospitalization were evaluated. Results: Preoperative mortality was 7.9%, and the total mortality was 8.7%. The prenatal detection rate increased after introducing systematic fetal anomaly screening from 5.0% to 37.7% during the study period (P <.0001), but the total mortality rate remained unchanged. All prenatally diagnosed infants (n = 27) survived. Lower gestational age (odds ratio 0.68, P =.012) and higher maternal age at birth (odds ratio 1.16, P =.036) were associated with increased mortality in multivariable analysis. Older infant age at time of operation (P =.002), longer aortic clamp time (P <.001), and higher maternal body mass index (P =.027) were associated with longer initial hospital stay. An extended need for hospital care during the first year of life was multi-factorial. Conclusions: In our cohort, none of the prenatally diagnosed d-TGA infants died. As a result of the limited prenatal detection rates, however, the sample size was insufficient to reach statistical significance. The d-TGA infants born with lower gestational age and to older mothers had increased mortality.
AB - Introduction: Newborn infants with transposition of the great arteries (d-TGA) need immediate care for an optimal outcome. This study comprised a nationwide 11-year population-based cohort of d-TGA infants, and assessed whether the implementation of a nationwide systematic fetal screening program, or other perinatal, or perioperative factors, are associated with mortality or an increased need for hospital care. Material and methods: The national cohort consisted of all live-born infants with simple d-TGA (TGA ± small ventricular septal defect, n = 127) born in Finland during 2004-2014. Data were collected from six national registries. Prenatal diagnosis and perinatal and perioperative factors associated with mortality and length of hospitalization were evaluated. Results: Preoperative mortality was 7.9%, and the total mortality was 8.7%. The prenatal detection rate increased after introducing systematic fetal anomaly screening from 5.0% to 37.7% during the study period (P <.0001), but the total mortality rate remained unchanged. All prenatally diagnosed infants (n = 27) survived. Lower gestational age (odds ratio 0.68, P =.012) and higher maternal age at birth (odds ratio 1.16, P =.036) were associated with increased mortality in multivariable analysis. Older infant age at time of operation (P =.002), longer aortic clamp time (P <.001), and higher maternal body mass index (P =.027) were associated with longer initial hospital stay. An extended need for hospital care during the first year of life was multi-factorial. Conclusions: In our cohort, none of the prenatally diagnosed d-TGA infants died. As a result of the limited prenatal detection rates, however, the sample size was insufficient to reach statistical significance. The d-TGA infants born with lower gestational age and to older mothers had increased mortality.
KW - hospitalization
KW - maternal body mass index
KW - mortality
KW - prenatal diagnosis
KW - transposition of great arteries
KW - transposition of great vessels
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U2 - 10.1111/aogs.13953
DO - 10.1111/aogs.13953
M3 - Article
C2 - 32640036
AN - SCOPUS:85088380068
SN - 0001-6349
VL - 99
SP - 1728
EP - 1735
JO - Acta obstetricia et gynecologica Scandinavica
JF - Acta obstetricia et gynecologica Scandinavica
IS - 12
ER -