Congenital Heart Disease in Premature Infants 25-32 Weeks' Gestational Age.
Congenital Heart Disease in Premature Infants 25-32 Weeks' Gestational Age.
复制标题
早产婴儿的先天性心脏病25-32周的胎龄。
DOI：
10.1016/j.jpeds.2016.10.033
复制
发表时间：
2017-02
期刊：
影响因子：
--
通讯作者：
Hill KD
中科院分区：
文献类型：
--
作者：
Chu PY;Li JS;Kosinski AS;Hornik CP;Hill KD
确定非常/极早产儿常见缺陷范围内先天性心脏缺陷（CHD）的出生患病率，并比较有CHD和无CHD的早产儿的死亡率。使用儿童住院患者数据库（2003-2012）估计胎龄（GA）25 - 32周的极/极早产儿中CHD（不包括动脉导管未闭）的出生患病率。将出生患病率与足月儿的一个“严重”缺陷子集进行比较，这些缺陷预计在新生儿期几乎被普遍诊断出来。采用加权多变量logistic回归分析计算校正后的死亡率比值比，比较有CHD的极早产儿和无CHD的极早产儿。我们确定了249，011名极早产儿，其中包括28，806名CHD。CHD的总体出生患病率为116/1000非常/极早产。与足月儿相比，重度CHD在极早产儿/极早产儿中的出生患病率显著更高（7.4/1000例极早产儿vs 1.5/1000例足月儿，p<0.001）。患有严重CHD的极/极早产儿总体住院死亡率为26.3%，与未患有CHD的早产儿相比，校正后死亡几率增加7.5倍。在极/极早产儿中，不同缺陷的死亡率差异很大，从主动脉弓中断的12%到动脉干的67%。鉴于极/极早产儿中重度CHD的出生患病率增加，死亡率显著升高，有理由进行强化干预，旨在降低宫内诊断CHD的患者早产的可能性。
To determine the birth prevalence of congenital heart defects (CHDs) across the spectrum of common defects in very/extremely premature infants and to compare mortality rates between premature infants with and without CHDs. The Kids' Inpatient Databases (2003-2012) were used to estimate the birth prevalence of CHDs (excluding patent ductus arteriosus) in very/extremely premature infants born between 25 and 32 weeks gestational age (GA). Birth prevalence was compared with term infants for a subset of “severe” defects expected to be near universally diagnosed in the neonatal period. Weighted multivariable logistic regression was used to calculate adjusted odds ratios of mortality comparing very and extremely premature infants with versus without CHDs. We identified 249,011 very/extremely premature infants, including 28,806 with CHDs. The overall birth prevalence of CHDs was 116 per 1000 very/extremely premature births. Severe CHDs had significantly higher birth prevalence in very/extremely premature infants when compared with term infants (7.4 per 1000 very/premature births versus 1.5 per 1000 term births, p<0.001). Very/extremely premature infants with severe CHDs had an overall 26.3% in-hospital mortality and a 7.5-fold increased adjusted odds of death compared with those without CHDs. Mortality varied widely by defect in very/extremely premature infants, ranging from 12% for interrupted aortic arch to 67% for truncus arteriosus. Given the increased birth prevalence of severe CHDs in very/extremely premature infants, and significantly higher mortality, there is justification for intensive interventions aimed at decreasing the likelihood of premature delivery for patients where CHD is diagnosed in utero.