Survival, by Birth Weight and Gestational Age, in Individuals With Congenital Heart Disease: A Population-Based Study.
Survival, by Birth Weight and Gestational Age, in Individuals With Congenital Heart Disease: A Population-Based Study.
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DOI：
10.1161/jaha.116.005213
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发表时间：
2017-07-21
影响因子：
5.4
通讯作者：
Rankin J
中科院分区：
文献类型：
--
作者：
Best KE;Tennant PWG;Rankin J
先天性心脏病（CHD）的生存率估计对于了解预后和评估健康和社会护理需求非常重要。很少有研究报道根据母体和胎儿特征估计CHD存活率。本研究旨在确定CHD生存的预测因子并报告条件生存估计值。将1985-2003年出生并通知北方先天性异常调查（NorCAS）的CHD病例（n=5070）与2008年的全国死亡率信息进行匹配。进行Royston-Parmar回归以确定生存预测因子。根据分娩时胎龄、出生体重和出生年份，对孤立性CHD（即无心外异常的CHD）进行5年生存率估计。出生年份、胎龄、出生体重和心外畸形与死亡率独立相关（均P≤0.001）。2003年足月（37-41周）出生且平均出生体重（在平均值的1个标准差内）的儿童的5年生存率为96.3%（95% CI，95.6-97.0）。高出生体重儿（平均值>1 SD）的生存率最乐观（≥42周; 97.9%; 95% CI，96.8-99.1%），极早产儿（<32周）低出生体重儿（平均值<1 SD）的生存率最不乐观（78.8%; 95% CI，72.8-99.1）。5年CHD生存率受胎龄和出生体重的影响很大。对于产前咨询，条件生存估计提供了最好和最坏的情况下，这取决于最终胎龄和出生体重。对于产后诊断，他们可以根据婴儿的出生体重和胎龄为父母提供更准确的预测。
Congenital heart disease (CHD) survival estimates are important to understand prognosis and evaluate health and social care needs. Few studies have reported CHD survival estimates according to maternal and fetal characteristics. This study aimed to identify predictors of CHD survival and report conditional survival estimates. Cases of CHD (n=5070) born during 1985–2003 and notified to the Northern Congenital Abnormality Survey (NorCAS) were matched to national mortality information in 2008. Royston–Parmar regression was performed to identify predictors of survival. Five‐year survival estimates conditional on gestational age at delivery, birth weight, and year of birth were produced for isolated CHD (ie, CHD without extracardiac anomalies). Year of birth, gestational age, birth weight, and extracardiac anomalies were independently associated with mortality (all P≤0.001). Five‐year survival for children born at term (37–41 weeks) in 2003 with average birth weight (within 1 SD of the mean) was 96.3% (95% CI, 95.6–97.0). Survival was most optimistic for high‐birth‐weight children (>1 SD from the mean) born post‐term (≥42 weeks; 97.9%; 95% CI, 96.8–99.1%) and least optimistic for very preterm (<32 weeks) low‐birth‐weight (<1 SD from mean) children (78.8%; 95% CI, 72.8–99.1). Five‐year CHD survival is highly influenced by gestational age and birth weight. For prenatal counseling, conditional survival estimates provide best‐ and worst‐case scenarios, depending on final gestational age and birth weight. For postnatal diagnoses, they can provide parents with more‐accurate predictions based on their baby's birth weight and gestational age.