Perinatal and perioperative factors associated with mortality and an increased need for hospital care in infants with transposition of the great arteries: A nationwide 11-year population-based cohort

Acta Obstet Gynecol Scand. 2020 Dec;99(12):1728-1735. doi: 10.1111/aogs.13953. Epub 2020 Jul 23.

Abstract

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.

Keywords: hospitalization; maternal body mass index; mortality; prenatal diagnosis; transposition of great arteries; transposition of great vessels.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Body Mass Index
  • Cohort Studies
  • Female
  • Finland / epidemiology
  • Gestational Age
  • Hospitalization / statistics & numerical data*
  • Humans
  • Infant
  • Infant Mortality
  • Infant, Newborn
  • Maternal Age
  • Neonatal Screening / methods
  • Obesity, Maternal* / diagnosis
  • Obesity, Maternal* / epidemiology
  • Pregnancy
  • Prenatal Diagnosis / methods
  • Prenatal Diagnosis / statistics & numerical data
  • Risk Factors
  • Transposition of Great Vessels* / diagnosis
  • Transposition of Great Vessels* / mortality
  • Transposition of Great Vessels* / therapy