Jung Il Kwak, Soo Hyun Kim, Kyusang Yoo, Tae-Gyeong Kim, Juhee Park, Abraham Kwak, Joo Hyung Roh, Jeong Min Lee, Ha Na Lee, Jiyoon Jeong, Chae Young Kim, Euiseok Jung, Byong Sop Lee
Asan Medical Center Children’s Hospital and University of Ulsan College of Medicine.
Republic of Korea
Korean Circulation Journal
Korean Circ J 2026;
DOI: 10.4070/kcj.2026.0106
Abstract
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.
Category
Class I. Pulmonary Hypertension Associated with Congenital Cardiovascular Disease
Class III. Pulmonary Hypertension Associated with Lung Disease
Symptoms and Findings Associated with Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes