Perinatal and perioperative factors associated with mortality and an increased need for hospital care in infants with transposition of the great arteries: a nationwide 11-year population-based cohort.

INTRODUCTION Newborns with transposition of the great arteries (d-TGA) need immediate care for an optimal outcome. This study comprised a nationwide 11-year population-based cohort of d-TGA infants, and assessed whether the implementation of a nationwide systematic fetal screening program, or other perinatal - or perioperative factors, are associated with mortality or an increased need for hospital care. MATERIAL AND METHODS The national cohort consisted of all live-born infants with simple d-TGA (TGA +/- small ventricular septal defect, n = 127) born in Finland during 2004-2014. Data were collected from six national registries. Prenatal diagnosis and perinatal and perioperative factors associated with mortality and length of hospitalization were evaluated. RESULTS Preoperative mortality was 7.9%, and the total mortality was 8.7%. The prenatal detection rate increased after introducing systematic fetal anomaly screening from 5.0% to 37.7% during the study period (P < 0.0001), but the total mortality rate remained unchanged. All prenatally diagnosed infants (n = 27) survived. Lower gestational age (OR 0.68, P = 0.012) and higher maternal age at birth (OR 1.16, P = 0.036) were associated with increased mortality in multivariable analysis. The older infant age at time of operation (P = 0.002), longer aortic clamp time (P < 0.001), and higher maternal BMI (P = 0.027) were associated with longer initial hospital stay. An extended need for hospital care during the first year of life was multi-factorial. CONCLUSIONS In our cohort, none of the prenatally diagnosed d-TGA patients died. Due to the limited prenatal detection rates, however, the sample size was insufficient to reach statistical significance. D-TGA infants born with lower gestational age and to older mothers had increased mortality.