A1 Refereed original research article in a scientific journal
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
Authors: Hautala J, Gissler M, Ritvanen A, Helle E, Pihkala J, Mattila IP, Pätilä T, Salminen J, Puntila J, Jokinen E, Räsänen J, Vahlberg T, Ojala T
Publisher: WILEY
Publication year: 2020
Journal: Acta Obstetricia et Gynecologica Scandinavica
Journal name in source: ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA
Journal acronym: ACTA OBSTET GYN SCAN
Volume: 99
Issue: 12
First page : 1728
Last page: 1735
Number of pages: 8
ISSN: 0001-6349
eISSN: 1600-0412
DOI: https://doi.org/10.1111/aogs.13953
Self-archived copy’s web address: https://helda.helsinki.fi/bitstream/10138/332531/1/Perinatal_and_perioperative_factors_associated_with_mortality_and_an_increased_need_for.pdf
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.
