Neonatal Depression Is Associated With 1-Year Mortality in Critical Congenital Heart Disease

Kimberley G. Miles, James Liu, Stephanie Y. Tseng, Emily A. Defranco, Allison A. Divanovic, Helen N. Jones, Nicholas J. Ollberding, James F. Cnota

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


BACKGROUND: Low 5-minute Apgar scores (AS) are predictive of term and preterm neonatal mortality but have not been well studied in the critical congenital heart disease (CCHD) population. We analyzed US national vital statistics data to evaluate the association between neonatal depression (AS 0–3) and 1-year mortality in CCHD. METHODS AND RESULTS: We performed a retrospective cohort study using 2014 to 2018 Centers for Disease Control and Prevention cohort-linked birth certificate and infant death records. Five-minute AS were categorized as ≤3, 4 to 6, or ≥7. We calculated birth rates and associated mortality rates by AS group in infants with and without CCHD. Multivariable logistic regression analyzed neonatal, maternal, and pregnancy-related risk factors for neonatal depression and 1-year mortality. Of 11 642 neonates with CCHD (0.06% of all births), the 5.8% with AS 0 to 3 accounted for 23.3% of all 1-year CCHD mortality, with 69.9% of deaths occurring within 1 month of life. Gestational age at birth, growth restriction, extracardiac defects, race, and low maternal education were associated with an increased odds of AS 0 to 3 in neonates with CCHD relative to those with AS 7 to 10 on multivariable analysis. AS 0 to 3 was associated with 1-year CCHD mortality after adjusting for these factors, prenatal care, and delivery location (adjusted odds ratio, 14.57 [95% CI, 11.73–18.10]). CONCLUSIONS: The AS is a routine clinical measure providing important prognostic information in CCHD. These findings sug-gest that prenatal and perinatal factors, beyond those included in current risk stratification tools, are important for CCHD out-comes. Multidisciplinary collaboration to understand the pathophysiology underlying neonatal depression may help identify interventions to improve CCHD mortality rates.

Original languageEnglish
Article numbere028774
JournalJournal of the American Heart Association
Issue number11
StatePublished - 2023

Bibliographical note

Publisher Copyright:
© 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.


  • 1-year mortality
  • Apgar score
  • critical congenital heart disease
  • neonatal depression

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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