Neonatal and 18-24-Month Growth and Neurodevelopmental Outcomes in Very Low Birth Weight Infants With Severe Congenital Heart Disease: A Korean Neonatal Network Study.

BACKGROUND AND

OBJECTIVES

Severe congenital heart disease (CHD) in very low birth weight (VLBW) infants poses substantial risks, yet contemporary national data remain limited. This study evaluated the prevalence, lesion spectrum, and neonatal and 18-24-month outcomes of VLBW infants with severe CHD in South Korea.

METHODS

We conducted a nationwide cohort study using the Korean Neonatal Network registry (2013-2021). Severe CHD was defined as a structural defect requiring surgical or catheter-based intervention within the first year of life and was categorized by physiological lesion type. Neonatal mortality, mortality before neonatal intensive care unit (NICU) discharge, major neonatal morbidities, and growth and neurodevelopmental outcomes at 18-24 months' corrected age were compared between infants with and without severe CHD.

RESULTS

Among 15,145 VLBW infants, 147 (1.0%) had severe CHD. Infants with severe CHD had higher neonatal mortality within 28 days (27.2% vs. 9.3%; adjusted odds ratio [OR], 3.37; 95% confidence interval [CI], 2.26-5.04) and mortality before NICU discharge (35.4% vs. 10.6%; adjusted OR, 5.95; 95% CI, 3.94-9.00) than those without severe CHD. Pulmonary hypertension, moderate-to-severe bronchopulmonary dysplasia, and necrotizing enterocolitis (stage ≥2) were more frequent in the severe CHD group. At 18-24 months, severe CHD was associated with higher rates of growth failure and neurodevelopmental impairment (34.1% vs. 20.0%; OR, 2.07, 95% CI, 1.32-3.24).

CONCLUSIONS

Severe CHD occurred in ~1% of VLBW infants and was associated with markedly higher mortality, greater neonatal morbidity, and increased risks of impaired growth and neurodevelopment at 18-24 months' corrected age.