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Congenital Heart Disease and Myelomeningocele in the Newborn: Prevalence and Mortality

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Abstract

Myelomeningocele (MMC) and congenital heart disease (CHD) are independent risk factors for increased morbidity and mortality in the newborn period and each can require significant operations shortly after birth. Few studies have examined the impact of these combined lesions. We sought to examine the incidence of CHD in patients with MMC, and to evaluate length of stay (LOS), hospital charges, and mortality. Using the Texas Inpatient Public Use Data File, ~ 6.9 million newborn records between 1/1999 and 12/2016 were examined. Hospitalizations were classified as MMC without CHD (n = 3054), CHD without MMC (n = 72,266), and MMC with CHD (n = 171). The birth prevalence of CHD with MMC was 0.3/10,000 live hospital births, with 5% of patients with MMC having CHD, and 0.2% of those with CHD having MMC. There was increased LOS in patients with both MMC and CHD (median 15 days, IQR 5–31), compared to CHD without MMC (median 6 days, IQR 2–20) and MMC without CHD (median 8 days, IQR 1–14) and higher total hospital charges (median $95,007, IQR $26,731–$222,660) compared to CHD without MMC (median $27,726, $6463–$118,370) and MMC without CHD (median $40,066, IQR $5744–$97,490). Mortality was significantly higher in patients with MMC and CHD (22.2% compared to 3.1% in MMC without CHD and 4.1% in CHD without MMC). Significance remained when limiting for patients without genetic conditions or additional major birth defects. MMC with CHD in the newborn compared to either CHD or MMC alone is associated with longer LOS, higher charges, and increased mortality.

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Data Availability

The Texas inpatient public use data file is available by request from the Texas Department of State Health Services.

Code Availability

International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or Tenth Revision, Clinical Modification (ICD-10) codes.

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Authors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, 6651 Main St, Houston, TX, E192077030, USA

    J. Kevin Wilkes, Yunfei Wang & Shaine A. Morris

  2. Division of Pediatric Neurosurgery, Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA

    William E. Whitehead

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  1. J. Kevin Wilkes
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  3. Yunfei Wang
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  4. Shaine A. Morris
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Contributions

JKW and SAM conceptualized and designed the study, carried out data analysis, drafted the initial manuscript, and reviewed and revised the manuscript. WEW critically reviewed and revised the manuscript for important intellectual content. YW assisted in data analysis. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to J. Kevin Wilkes.

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Wilkes, J.K., Whitehead, W.E., Wang, Y. et al. Congenital Heart Disease and Myelomeningocele in the Newborn: Prevalence and Mortality. Pediatr Cardiol 42, 1026–1032 (2021). https://doi.org/10.1007/s00246-021-02576-3

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  • DOI: https://doi.org/10.1007/s00246-021-02576-3

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