Congenital Heart Defects and Apgar Score at Birth, a Nationwide Study
Background Low Apgar scores have been associated with an increased risk of brain injury and neurodevelopmental disorders in newborns with congenital heart defects (CHDs). However, the relation between CHD subtypes and low Apgar scores remains unknown. This study aimed to assess the association betwe...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2025-04-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.038798 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850128428472205312 |
|---|---|
| author | Briyanth Ravichandran Tine B. Henriksen Vibeke E. Hjortdal John R. Ostergaard Niels B. Matthiesen |
| author_facet | Briyanth Ravichandran Tine B. Henriksen Vibeke E. Hjortdal John R. Ostergaard Niels B. Matthiesen |
| author_sort | Briyanth Ravichandran |
| collection | DOAJ |
| description | Background Low Apgar scores have been associated with an increased risk of brain injury and neurodevelopmental disorders in newborns with congenital heart defects (CHDs). However, the relation between CHD subtypes and low Apgar scores remains unknown. This study aimed to assess the association between major subtypes of CHD and low (<7) Apgar scores at 5 minutes. Methods and Results This population‐based study included 1 040 474 liveborn singletons in Denmark from 1997 to 2013. The association between CHD and low Apgar scores was estimated by confounder‐adjusted, multivariable logistic regression. In mediation analyses, the underlying mechanisms were examined. Low Apgar scores were present in 3.0% of newborns with CHD and in 0.7% of newborns without CHD. Overall, CHD was associated with an increased risk of a low Apgar score (adjusted odds ratio, 2.5 [95% CI, 2.1–3.0]). CHD subtypes associated with the highest risks were anomalous pulmonary venous return (adjusted odds ratio, 5.7 [95% CI, 2.2–14.9]), hypoplastic left heart syndrome (adjusted odds ratio, 5.1 [95% CI, 2.2–11.8]), and transposition of the great arteries (adjusted odds ratio, 3.5 [95% CI, 1.7–7.4]). In mediation analyses, preterm birth explained 25.2% (95% CI, 11.8–38.6) of the association between CHD and low Apgar scores. Conclusions Nearly all CHD subtypes were associated with an increased risk of a low Apgar score. The association was most pronounced in severe and potentially cyanotic types of CHD. These findings suggest that CHD is associated with a complicated fetal‐to‐neonatal transition and highlight the potential for improvements of this process in infants with CHD. |
| format | Article |
| id | doaj-art-5829b3bf059f4b95b3b42a1c1ed953f0 |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-5829b3bf059f4b95b3b42a1c1ed953f02025-08-20T02:33:19ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-04-0114810.1161/JAHA.124.038798Congenital Heart Defects and Apgar Score at Birth, a Nationwide StudyBriyanth Ravichandran0Tine B. Henriksen1Vibeke E. Hjortdal2John R. Ostergaard3Niels B. Matthiesen4Department of Paediatrics and Adolescent Medicine Aarhus University Hospital Aarhus DenmarkDepartment of Paediatrics and Adolescent Medicine Aarhus University Hospital Aarhus DenmarkDepartment of Cardiothoracic Surgery Copenhagen University Hospital‐Rigshospitalet Copenhagen DenmarkPediatric and Adolescent Medicine Centre for Rare Diseases, Aarhus University Hospital Aarhus DenmarkDepartment of Paediatrics and Adolescent Medicine Aarhus University Hospital Aarhus DenmarkBackground Low Apgar scores have been associated with an increased risk of brain injury and neurodevelopmental disorders in newborns with congenital heart defects (CHDs). However, the relation between CHD subtypes and low Apgar scores remains unknown. This study aimed to assess the association between major subtypes of CHD and low (<7) Apgar scores at 5 minutes. Methods and Results This population‐based study included 1 040 474 liveborn singletons in Denmark from 1997 to 2013. The association between CHD and low Apgar scores was estimated by confounder‐adjusted, multivariable logistic regression. In mediation analyses, the underlying mechanisms were examined. Low Apgar scores were present in 3.0% of newborns with CHD and in 0.7% of newborns without CHD. Overall, CHD was associated with an increased risk of a low Apgar score (adjusted odds ratio, 2.5 [95% CI, 2.1–3.0]). CHD subtypes associated with the highest risks were anomalous pulmonary venous return (adjusted odds ratio, 5.7 [95% CI, 2.2–14.9]), hypoplastic left heart syndrome (adjusted odds ratio, 5.1 [95% CI, 2.2–11.8]), and transposition of the great arteries (adjusted odds ratio, 3.5 [95% CI, 1.7–7.4]). In mediation analyses, preterm birth explained 25.2% (95% CI, 11.8–38.6) of the association between CHD and low Apgar scores. Conclusions Nearly all CHD subtypes were associated with an increased risk of a low Apgar score. The association was most pronounced in severe and potentially cyanotic types of CHD. These findings suggest that CHD is associated with a complicated fetal‐to‐neonatal transition and highlight the potential for improvements of this process in infants with CHD.https://www.ahajournals.org/doi/10.1161/JAHA.124.038798Apgar scorecongenital heart diseaseneonatologypediatric cardiology |
| spellingShingle | Briyanth Ravichandran Tine B. Henriksen Vibeke E. Hjortdal John R. Ostergaard Niels B. Matthiesen Congenital Heart Defects and Apgar Score at Birth, a Nationwide Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease Apgar score congenital heart disease neonatology pediatric cardiology |
| title | Congenital Heart Defects and Apgar Score at Birth, a Nationwide Study |
| title_full | Congenital Heart Defects and Apgar Score at Birth, a Nationwide Study |
| title_fullStr | Congenital Heart Defects and Apgar Score at Birth, a Nationwide Study |
| title_full_unstemmed | Congenital Heart Defects and Apgar Score at Birth, a Nationwide Study |
| title_short | Congenital Heart Defects and Apgar Score at Birth, a Nationwide Study |
| title_sort | congenital heart defects and apgar score at birth a nationwide study |
| topic | Apgar score congenital heart disease neonatology pediatric cardiology |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.038798 |
| work_keys_str_mv | AT briyanthravichandran congenitalheartdefectsandapgarscoreatbirthanationwidestudy AT tinebhenriksen congenitalheartdefectsandapgarscoreatbirthanationwidestudy AT vibekeehjortdal congenitalheartdefectsandapgarscoreatbirthanationwidestudy AT johnrostergaard congenitalheartdefectsandapgarscoreatbirthanationwidestudy AT nielsbmatthiesen congenitalheartdefectsandapgarscoreatbirthanationwidestudy |