Risk factors of mortality in neonatal cardiovascular intervention at tertiary hospital: A case-control study

Objective: Congenital heart disease (CHD) remains a leading cause of morbidity and mortality in neonates. While cardiovascular interventions can enhance hemodynamic stability, their success and associated mortality are influenced by multiple factors, including sepsis, prematurity, the need for mechanical ventilation prior to intervention, and procedure duration. This study aimed to determine whether these factors are associated with mortality in neonates undergoing cardiac intervention. Methods: This observational case-control study included 111 neonates who underwent cardiac interventions between 2015 and 2024. The case group comprised patients who did not survive post-intervention, while the control group included survivors. Chi-square tests and logistic regression analyses were conducted to identify mortality-associated risk factors. Results: Among the 111 subjects, 41 were non-survivors and 70 were survivors. Mechanical ventilation prior to intervention was required in 60% of non-survivors, indicating more severe preoperative conditions. This factor was significantly associated with mortality (OR: 5.571; 95% CI: 2.408–12.893; p < 0.001). Multivariate analysis confirmed that pre-procedural mechanical ventilation remained an independent predictor of mortality (adjusted OR: 5.168; 95% CI: 2.211–12.079; p < 0.001). Conclusion: This study highlights pre-intervention mechanical ventilation as a significant and independent risk factor for mortality in neonates undergoing cardiovascular interventions. Neonates requiring mechanical respiratory support prior to the procedure were over five times more likely to experience fatal outcomes, indicating that the severity of their preoperative condition plays a pivotal role in prognosis. These findings underscore the importance of early recognition, timely stabilization, and optimization of respiratory status before cardiac procedures. Incorporating this risk factor into preoperative assessment protocols may improve patient selection, guide resource allocation, and potentially enhance survival rates in this vulnerable population. Further multicenter studies are warranted to validate these findings and explore additional modifiable predictors of mortality.