Mortality and associated risk factors in neonates with critical congenital heart disease: A retrospective single-center study

Abstract

Objective: Congenital heart diseases (CHDs) include congenital structural and functional abnormalities of the cardiovascular system and are associated with a high risk of mortality and morbidity. To evaluate early outcomes in infants with congenital heart disease (CHD), with a particular focus on critical CHD (CCHD), and to identify factors associated with mortality in patients with CCHD. Material and Methods: Patients were grouped into five categories according to echocardiographic findings and clinical presentations: normal, non-significant, important, serious, and critical. In addition, all patients who underwent surgery for CHD were evaluated according to the RACHS-1 classification. Results: CCHD (serious/critical) constituted 11.6% (71/608) of CHD cases. Mortality occurred in 32 of 71 neonates with CCHD (45.1%). Antenatal diagnosis (OR: 3.1), inoperability (OR: 4.6), ventilation requirement (OR: 8.1), and postoperative arrhythmia (OR: 8.4) were identified as risk factors for mortality in patients with CCHD. In multiple logistic regression analysis, genetic syndrome (OR: 17.3, 95% CI [1.04–28.7], p=0.010) and postoperative arrhythmia (OR: 42.6, 95% CI [4.1– 44.09], p=0.002) were the strongest risk factors for mortality. Conclusion: Integration of echocardiographic and risk-based classifications may guide better clinical decision-making in patients with CCHD. Early identification, antenatal diagnosis, and preoperative stabilization are key to improving outcomes. The risk of mortality was higher in patients who required mechanical ventilation, had genetic anomalies, or developed postoperative arrhythmias.