DOI: 10.1161/jaha.125.047668 ISSN: 2047-9980

Prematurity Predicts Neurodevelopmental Outcomes in Congenital Heart Disease

Jenna A. Katz, Kimberlee Gauvreau, Samantha C. Butler, Anjali Sadhwani, Philip T. Levy, Aditya Kaza, Meena Nathan, Jane W. Newburger
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Background

Neurodevelopmental impairment is common in both prematurity and congenital heart disease (CHD). Preterm infants with CHD may have a “double hit,” with worse neurodevelopmental impairments than seen in prematurity or CHD alone.

Methods

This single‐center retrospective cohort study included children with CHD who underwent cardiac surgery in infancy (2007–2020) and completed neurodevelopmental testing. Using the Bayley Scales of Infant and Toddler Development, Third Edition, we assessed cognitive, language, and motor outcomes. Patients were stratified by gestational age: extremely/very/moderately preterm (≤33 weeks), late‐preterm (34–36 weeks), early‐term (37–38 weeks), or term/postterm (≥39 weeks). Multivariable linear regression was used to model Bayley scores, adjusting for demographic, medical, and surgical covariates.

Results

Among 1350 infants who underwent cardiac surgery, 513 (38%) completed Bayley scale assessment at median age 28 months (interquartile range, 19–34). 448 (87%) were full term and 65 (13%) preterm. After multivariable adjustment, gestational age remained a significant independent predictor of cognitive and motor scores. Children born ≤33 weeks had the worst outcomes, with age‐adjusted cognitive and motor composite scores 11 (95% CI, 5–17) and 15 (95% CI, 8–22) points lower, respectively, than those born at term. Other significant predictors included lower caregiver education, Black race, longer hospitalization, and genetic diagnosis. These models explained 17% to 26% of the variance in Bayley scores. The highest explained variance was in the motor domain.

Conclusions

Prematurity is a significant risk factor for adverse cognitive and motor outcomes in children with CHD, especially in those born ≤33 weeks. Enhanced neurodevelopmental surveillance and targeted early intervention strategies are warranted for this vulnerable population.

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