Variation in Prenatal Diagnosis of Congenital Heart Disease in Infants.
Variation in Prenatal Diagnosis of Congenital Heart Disease in Infants.
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DOI：
10.1542/peds.2014-3783
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发表时间：
2015-08
期刊：
影响因子：
8
通讯作者：
Ungerleider RM
中科院分区：
文献类型：
--
作者：
Quartermain MD;Pasquali SK;Hill KD;Goldberg DJ;Huhta JC;Jacobs JP;Jacobs ML;Kim S;Ungerleider RM
产前诊断可以改善某些形式的先天性心脏病（CHD）胎儿的围手术期结局。产前诊断的变异性已在其他国家得到证实，导致努力改善胎儿成像方案和获得护理，但尚未在美国各地进行检查。评估不同地理区域和缺陷类型的新生儿和接受心脏手术的CHD婴儿产前检测的国家差异。在美国境内年龄≤ 6个月的患者中进行的心血管手术并纳入STS-CHS外科数据库（2006-2012）有资格入选。缺失产前诊断数据>15%的中心被排除在研究之外。使用卡方检验比较居住地和缺陷类型的产前诊断率。总体而言，该研究包括来自美国91个STS-CHS参与中心的31，374名患者。产前检测率为34%，每年从26%（2006年）增加到42%（2012年）。各州产前诊断率存在显著的地理差异（范围为11.8 - 53.4%，p < 0.0001）。还观察到不同缺损类型的显著变异性，与需要流出道可视化的病变相比，在四腔视图上可识别病变的发生率更高（57% vs 32%，p < 0.0001）。在美国，接受手术干预的患者的产前CHD检出率仍然很低，各州之间和不同缺陷类型之间存在显著差异。需要进一步的研究来确定这种变化的原因以及对患者结局的潜在影响。
Prenatal diagnosis allows for improved peri-operative outcomes of fetuses with certain forms of congenital heart disease (CHD). Variability in prenatal diagnosis has been demonstrated in other countries, leading to efforts to improve fetal imaging protocols and access to care, but has not been examined across the United States. To evaluate national variation in prenatal detection across geographic region and defect type in neonates and infants with CHD undergoing heart surgery. Cardiovascular operations performed in patients ≤ 6 months of age within the United States and included in the STS-CHS Surgical Database (2006–2012) were eligible for inclusion. Centers with >15% missing prenatal diagnosis data were excluded from the study. Prenatal diagnosis rates were compared across geographic location of residence and defect type using the Chi-square test. Overall, the study included 31,374 patients from 91 STS-CHS participating centers across the United States. Prenatal detection occurred in 34% and increased every year from 26% (2006) to 42% (2012). There was significant geographic variation in rates of prenatal diagnosis across states (range 11.8 – 53.4%, p < 0.0001). Significant variability by defect type was also observed with higher rates for lesions identifiable on 4-chamber view versus those requiring outflow tract visualization (57% versus 32%, p < 0.0001). Rates of prenatal CHD detection in the United States remain low for patients undergoing surgical intervention, with significant variability between states and across defect type. Further studies are needed to identify reasons for this variation and the potential impact on patient outcomes.