Impaired Maternal-Fetal Environment and Risk for Preoperative Focal White Matter Injury in Neonates With Complex Congenital Heart Disease.
Impaired Maternal-Fetal Environment and Risk for Preoperative Focal White Matter Injury in Neonates With Complex Congenital Heart Disease.
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DOI：
10.1161/jaha.122.025516
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发表时间：
2023-04-04
影响因子：
5.4
通讯作者：
Putt, Mary E.
中科院分区：
文献类型：
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作者：
Licht, Daniel J.;Jacobwitz, Marin;Lynch, Jennifer M.;Ko, Tiffany;Boorady, Timothy;Devarajan, Mahima;Heye, Kristina N.;Mensah-Brown, Kobina;Newland, John J.;Schmidt, Alexander;Schwab, Peter;Winters, Madeline;Nicolson, Susan C.;Montenegro, Lisa M.;Fuller, Stephanie;Mascio, Christopher;Gaynor, J. William;Yodh, Arjun G.;Gebb, Juliana;Vossough, Arastoo;Choi, Grace H.;Putt, Mary E.
关键词：
患有先天性心脏病(CHD)的婴儿在新生儿心脏手术前存在脑白质损伤(WMI)的风险。更好地了解术前WMI的原因可能为改善这些患者的神经发育结果的干预措施提供洞察力。一项关于先心病新生儿术前体重指数的前瞻性单中心研究记录了主要心脏诊断、母胎环境(MFE)、分娩类型、受试者人体测量学和术前护理等数据。评估成熟度总分和WMI，并建立逐步Logistic回归模型，筛选WMI的危险因素。在183例严重冠心病术前接受脑磁共振成像的受试者中，40例(21.9%)患者发生了WMI。白质心肌梗死的患病率(21.4%-22.1%)和平均体积(119.7-160.4 mm~3)在冠心病诊断中是相似的。逐步Logistic回归分析选择MFE受损(优势比[OR]，2.85[95%CI，1.29~6.30])、男性(OR，2.27[95%CI，1.03~5.36])和高龄(OR，每天1.20[95%CI，1.03~1.41])作为术前WMI的危险因素，较高的总成熟评分值(OR，0.65每增加一单位[95%CI，0.43~0.95])作为保护性因素。四分之一(24.6%；n=45)的受试者有≥-1组分的MFE受损(妊娠期糖尿病12例，占6.6%，妊高征11例，占6.0%，子痫前期2例，占1.1%，吸烟9例，占4.9%，甲状腺功能减退6例，占3.3%，其他16例，占8.7%)。在138名受试者中，对其他MFE相关因素的探索性分析揭示了WMI的其他潜在风险因素。这项研究首次将MFE受损确定为术前WMI的重要危险因素。在CHD诊断中，术前WMI的易感性是相同的。
Infants with congenital heart disease (CHD) are at risk for white matter injury (WMI) before neonatal heart surgery. Better knowledge of the causes of preoperative WMI may provide insights into interventions that improve neurodevelopmental outcomes in these patients. A prospective single‐center study of preoperative WMI in neonates with CHD recorded data on primary cardiac diagnosis, maternal‐fetal environment (MFE), delivery type, subject anthropometrics, and preoperative care. Total maturation score and WMI were assessed, and stepwise logistic regression modeling selected risk factors for WMI. Among subjects with severe CHD (n=183) who received a preoperative brain magnetic resonance imaging, WMI occurred in 40 (21.9%) patients. WMI prevalence (21.4%–22.1%) and mean volumes (119.7–160.4 mm3) were similar across CHD diagnoses. Stepwise logistic regression selected impaired MFE (odds ratio [OR], 2.85 [95% CI, 1.29–6.30]), male sex (OR, 2.27 [95% CI, 1.03–5.36]), and older age at surgery/magnetic resonance imaging (OR, 1.20 per day [95% CI, 1.03–1.41]) as risk factors for preoperative WMI and higher total maturation score values (OR, 0.65 per unit increase [95% CI, 0.43–0.95]) as protective. A quarter (24.6%; n=45) of subjects had ≥1 components of impaired MFE (gestational diabetes [n=12; 6.6%], gestational hypertension [n=11; 6.0%], preeclampsia [n=2; 1.1%], tobacco use [n=9; 4.9%], hypothyroidism [n=6; 3.3%], and other [n=16; 8.7%]). In a subset of 138 subjects, an exploratory analysis of additional MFE‐related factors disclosed other potential risk factors for WMI. This study is the first to identify impaired MFE as an important risk factor for preoperative WMI. Vulnerability to preoperative WMI was shared across CHD diagnoses.
DOI：
10.1002/uog.18919
发表时间：
2018-10
期刊：
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
影响因子：
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作者：
Szwast A;Putt M;Gaynor JW;Licht DJ;Rychik J
通讯作者：
Rychik J