{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T05:28:27Z","timestamp":1767245307656,"version":"3.48.0"},"reference-count":34,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:00:00Z","timestamp":1767052800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003053","name":"Alberta Health","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003053","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Stollery Children\u2019s Hospital"},{"name":"Women and Children\u2019s Health Research Institute"},{"name":"Glenrose Rehabilitation Hospital Research Trust"},{"name":"Glenrose Rehabilitation Hospital"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Introduction: To explore whether antenatal and preoperative factors predict disability-free survival of preterm newborns with biventricular complex congenital heart defects (CHD). Methods: Retrospective cohort study, using the prospectively designed database of Complex Pediatric Therapies Follow Up Program and a chart review of mother\u2013newborn dyads, born under 37 weeks\u2019 gestation with biventricular complex CHD, between 1997 and 2019, who had open heart surgery up to 6 weeks corrected age. Surviving children had neurodevelopmental assessments between 18 and 24 months corrected age. Bayley Scales of Infant Development, 2nd edition, and Bayley Scales of Infant and Toddler Development, 3rd edition, assessed cognitive, language, and motor skills; Adaptive Behavior Assessment System, 3rd edition, assessed adaptive skills. Univariate and multivariate analyses assessed predictors of mortality, disability (cerebral palsy, visual impairment, permanent hearing loss), and neurodevelopmental delay. Results: Of 84 preterm newborns (34.6 \u00b1 2.1 weeks\u2019 gestation, 2321 \u00b1 609 g, 57% males), 8 (9.5%) died by 2 years of age; 69 (91%) survived without and 7 (9%) with disability. Chorioamnionitis was associated with death [Hazard ratio 7.92 (95% CI 1.3, 33.3), p = 0.025]; prolonged rupture of membranes was associated with disability [Odds Ratio 9.7 (95% CI 1.99, 46.9), p = 0.005]. Maternal diabetes, antenatal diagnosis of CCHD, birth head circumference, cardiopulmonary resuscitation, and chromosomal anomalies were associated with adverse neurodevelopment. Conclusions: Chorioamnionitis and prolonged rupture of membranes are associated with worse outcomes in preterm newborns with biventricular complex CHD up to 2 years of age. Adverse neurodevelopmental outcomes are associated with maternal diabetes and antenatal diagnosis of CCHD. Prospective studies are needed to confirm these results.<\/jats:p>","DOI":"10.3390\/children13010049","type":"journal-article","created":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T16:08:00Z","timestamp":1767197280000},"page":"49","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Antenatal and Preoperative Factors Associated with 2-Year Outcome of Preterm Newborns with Biventricular Complex Congenital Heart Defects: A 23-Year Cohort Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1863-2690","authenticated-orcid":false,"given":"Mosarrat","family":"Qureshi","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2R3, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Amiri","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health, University of Alberta, Edmonton, AB T6G 2R3, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irina A.","family":"Dinu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health, University of Alberta, Edmonton, AB T6G 2R3, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Vrban-McRae","sequence":"additional","affiliation":[{"name":"Complex Pediatric Therapies Follow up Program, Department of Pediatrics, Glenrose Rehabilitation Hospital, Edmonton, AB T5G 0B7, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4509-3848","authenticated-orcid":false,"given":"Winnie","family":"Savard","sequence":"additional","affiliation":[{"name":"Complex Pediatric Therapies Follow up Program, Department of Pediatrics, Glenrose Rehabilitation Hospital, Edmonton, AB T5G 0B7, Canada"},{"name":"Faculty of Nursing, University of Alberta, Edmonton, AB T6G 2R3, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6306-4234","authenticated-orcid":false,"given":"Charlene M.T.","family":"Robertson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2R3, Canada"},{"name":"Complex Pediatric Therapies Follow up Program, Department of Pediatrics, Glenrose Rehabilitation Hospital, Edmonton, AB T5G 0B7, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7141-1523","authenticated-orcid":false,"given":"Po-Yin","family":"Cheung","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2R3, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,30]]},"reference":[{"key":"ref_1","unstructured":"Aminoff, M.J., and Josephson, S.A. (2021). Neurologic Complications of Congenital Heart Disease and Cardiac Surgery in Children. Aminoff\u2019s Neurology and General Medicine, Academic Press."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1016\/j.jtcvs.2009.03.071","article-title":"An empirically based tool for analyzing mortality associated with congenital heart surgery","volume":"138","author":"Clarke","year":"2009","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1016\/j.jtcvs.2006.10.087","article-title":"Patient characteristics are important determinants of neurodevelopmental outcomes at one year of age after neonatal and infant cardiac surgery","volume":"133","author":"Gaynor","year":"2007","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Cheung, P.-Y., Hajihosseini, M., Dinu, I.A., Switzer, H., Joffe, A.R., Bond, G.Y., Robertson, C.M.T., and on behalf of the Western Canadian Complex Pediatric Therapies Follow-up Program (2021). Outcomes of preterm infants with congenital heart defects after early surgery: Defining risk factors at different time points during hospitalization. Front. Pediatr., 8.","DOI":"10.3389\/fped.2020.616659"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.jtcvs.2011.11.029","article-title":"Younger gestational age is associated with worse neurodevelopmental outcomes after cardiac surgery in infancy","volume":"143","author":"Goff","year":"2012","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e2301","DOI":"10.1002\/bdr2.2301","article-title":"National population-based estimates for major birth defects, 2016\u20132020","volume":"116","author":"Stallings","year":"2024","journal-title":"Birth Defects Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1161\/CIRCULATIONAHA.112.001054","article-title":"Association between maternal chronic conditions and congenital heart defects: A population-based cohort study","volume":"128","author":"Liu","year":"2013","journal-title":"Circulation"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Zloto, K., Hochberg, A., Tenenbaum-Gavish, K., Berezowsky, A., Barbash-Hazan, S., Bardin, R., Hadar, E., and Shmueli, A. (2022). Fetal congenital heart disease\u2014Mode of delivery and obstetrical complications. BMC Pregnancy Childbirth, 22.","DOI":"10.1186\/s12884-022-04910-w"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1038\/s41390-021-01633-0","article-title":"Chorioamnionitis and neonatal outcomes","volume":"91","author":"Jain","year":"2022","journal-title":"Pediatr. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.jpeds.2003.09.048","article-title":"Outcomes from an interprovincial program of newborn open heart surgery","volume":"144","author":"Robertson","year":"2004","journal-title":"J. Pediatr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1016\/j.jtcvs.2005.04.029","article-title":"Postoperative lactate concentrations predict the outcome of infants aged 6 weeks or less after intracardiac surgery: A cohort follow-up to 18 months","volume":"130","author":"Cheung","year":"2005","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"965740","DOI":"10.4061\/2011\/965740","article-title":"The registry and follow-up of complex pediatric therapies program of Western Canada: A mechanism for service, audit, and research after life-saving therapies for young children","volume":"2011","author":"Robertson","year":"2011","journal-title":"Cardiol. Res. Pract."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1111\/j.1469-8749.2007.tb12610.x","article-title":"A report: The definition and classification of cerebral palsy","volume":"49","author":"Rosenbaum","year":"2007","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_14","unstructured":"Bayley, N. (1993). Bayley Scales of Infant Development, The Psychological Corporation. [2nd ed.]."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Bayley, N. (2006). Bayley Scales of Infant and Toddler Development, Harcourt Assessment Inc.. [3rd ed.].","DOI":"10.1037\/t14978-000"},{"key":"ref_16","unstructured":"Harrison, P.L., and Oakland, T. (2000). Adaptive Behavior Assessment System, Psychological Corporation."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Fenton, T.R., and Kim, J.H. (2013). A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatrics., 13.","DOI":"10.1186\/1471-2431-13-59"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2226","DOI":"10.1161\/01.CIR.92.8.2226","article-title":"Post-operative course and hemodynamic profile after the arterial switch operation in neonates and infants: A comparison of low-flow cardiopulmonary bypass and circulatory arrest","volume":"92","author":"Wernovsky","year":"1995","journal-title":"Circulation"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Goldstein, J.A., Gallagher, K., Beck, C., Kumar, R., and Gernand, A.D. (2020). Maternal-fetal inflammation in the placenta and the developmental origins of health and disease. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.531543"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/S0095-5108(18)30159-3","article-title":"Brain injury in the premature infant: Neuropathology, clinical aspects, pathogenesis, and prevention","volume":"24","author":"Volpe","year":"1997","journal-title":"Clin. Perinatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e033189","DOI":"10.1161\/JAHA.123.033189","article-title":"Placental pathology contributes to impaired volumetric brain development in neonates with congenital heart disease","volume":"13","author":"Nijman","year":"2024","journal-title":"J. Am. Heart Assoc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"662","DOI":"10.3109\/14767058.2011.597900","article-title":"Fetal congenital heart disease and intrauterine growth restriction: A retrospective cohort study","volume":"25","author":"Wallenstein","year":"2012","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"101217","DOI":"10.1016\/j.ajogmf.2023.101217","article-title":"Gestational diabetes mellitus and risk of neurodevelopmental disorders in young offspring: Does the risk differ by race and ethnicity?","volume":"6","author":"Liu","year":"2024","journal-title":"Am. J. Obstet. Gynecol. MFM"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"100213","DOI":"10.1016\/j.ajogmf.2020.100213","article-title":"Adverse neonatal outcomes associated with pregestational diabetes mellitus in infants born preterm","volume":"2","author":"Tse","year":"2020","journal-title":"Am. J. Obstet. Gynecol. MFM"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Rodolaki, K., Pergialiotis, V., Iakovidou, N., Boutsikou, T., Iliodromiti, Z., and Kanaka-Gantenbein, C. (2023). The impact of maternal diabetes on the future health and neurodevelopment of the offspring: A review of the evidence. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1125628"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Paton, M.C.B., McDonald, C.A., Allison, B.J., Fahey, M.C., Jenkin, G., and Miller, S.L. (2017). Perinatal brain injury as a consequence of preterm birth and intrauterine inflammation: Designing targeted stem Cell therapies. Front. Neurosci., 11.","DOI":"10.3389\/fnins.2017.00200"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1017\/S1047951122002013","article-title":"Abnormal infant neurobehavior and later neurodevelopmental delays in children with critical CHD","volume":"33","author":"Campbell","year":"2023","journal-title":"Cardiol. Young"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1002\/pd.3991","article-title":"Prenatal diagnosis of congenital heart disease: Impact of mode of delivery on neonatal outcome","volume":"32","author":"Trento","year":"2012","journal-title":"Prenat. Diagn."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Chen, X., Zhang, X., Li, W., Li, W., Wang, Y., Zhang, S., and Zhu, C. (2021). Iatrogenic vs. spontaneous preterm birth: A retrospective study of neonatal outcome among very preterm infants. Front. Neurol., 12.","DOI":"10.3389\/fneur.2021.649749"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e154450","DOI":"10.1001\/jamapediatrics.2015.4450","article-title":"Association of Prenatal Diagnosis of Critical Congenital Heart Disease with postnatal brain development and the risk of brain injury","volume":"170","author":"Peyvandi","year":"2016","journal-title":"JAMA Pediatr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.jpeds.2011.12.036","article-title":"Impact of prenatal diagnosis on neurocognitive outcomes in children with transposition of the great arteries","volume":"161","author":"Calderon","year":"2012","journal-title":"J. Pediatr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2932","DOI":"10.1093\/cercor\/bhs281","article-title":"Delayed cortical development in fetuses with complex congenital heart disease","volume":"23","author":"Clouchoux","year":"2013","journal-title":"Cereb. Cortex"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.tins.2018.12.003","article-title":"Cortical dysmaturation in congenital heart disease","volume":"42","author":"Leonetti","year":"2019","journal-title":"Trends Neurosci."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e794","DOI":"10.1542\/peds.2011-0331","article-title":"Overestimating neurodevelopment using the Bayley-III after early complex cardiac surgery","volume":"128","author":"Acton","year":"2011","journal-title":"Pediatrics"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/1\/49\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T05:24:34Z","timestamp":1767245074000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/1\/49"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,30]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["children13010049"],"URL":"https:\/\/doi.org\/10.3390\/children13010049","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2025,12,30]]}}}