Prenatal Diagnosis of Congenital Heart Disease and Birth Outcomes
Prenatal Diagnosis of Congenital Heart Disease and Birth Outcomes
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DOI：
10.1007/s00246-012-0504-4
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发表时间：
2013-03-01
影响因子：
1.6
通讯作者：
Williams, Ismee A.
中科院分区：
文献类型：
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作者：
Landis, Benjamin J.;Levey, Allison;Williams, Ismee A.
本研究旨在探讨产前诊断先天性心脏病（CHD）对出生和早期新生儿结局的影响。在过去的十年中，产前诊断的CHD的患病率有所上升，但产前诊断CHD对围产期决策的影响仍不清楚。产前诊断对新生儿结局的影响尚无共识。在2004年1月至2009年7月期间，对所有入住我院新生儿重症监护室的CHD新生儿进行了回顾性病历审查。收集产科和产后变量。在993例受试者中，678例（68.3%）进行了产前诊断。产前诊断增加了计划分娩的几率[比值比（OR）4.1，95%置信区间（CI）3.0-5.6]和引产（OR 11.5，95% CI 6.6-20.1）。产前诊断与剖腹产无显著相关性，但以母亲年龄、多胎妊娠和心外畸形为对照。平均胎龄对产前诊断没有影响，但产前诊断与胎龄39周前分娩的几率增加（OR 1.5，95% CI 1.1-1.9）和术前插管的几率降低（OR 0.5，95% CI 0.3-0.6）相关。产前诊断对术前或出院前死亡率没有影响。产前诊断与计划分娩的几率增加、胎龄39周前出生以及对侵入性呼吸支持的需求减少相关。产前诊断冠心病与术前或出院前死亡率无关。
This study was undertaken to examine the impact that prenatal diagnosis of congenital heart disease (CHD) has on birth and early neonatal outcomes. The prevalence of prenatally diagnosed CHD has risen over the past decade, but the effect that prenatal diagnosis of CHD has on peripartum decisions remains unclear. No consensus exists on the effect of prenatal diagnosis on neonatal outcomes. Between January 2004 and July 2009, a retrospective chart review of all neonates with CHD admitted to our institution's neonatal intensive care unit was conducted. Obstetric and postnatal variables were collected. Among the 993 subjects, 678 (68.3 %) had a prenatal diagnosis. A prenatal diagnosis increased the odds of a scheduled delivery [odds ratio (OR) 4.1, 95 % confidence interval (CI) 3.0-5.6] and induction of labor (OR 11.5, 95 % CI 6.6-20.1). Prenatal diagnosis was not significantly associated with cesarean delivery when control was used for maternal age, multiple gestation, and presence of extracardiac anomaly. Mean gestational age had no impact on prenatal diagnosis, but prenatal diagnosis was associated with increased odds of delivery before a gestational age of 39 weeks (OR 1.5, 95 % CI 1.1-1.9) and decreased odds of preoperative intubation (OR 0.5, 95 % CI 0.3-0.6). Prenatal diagnosis did not have an impact on preoperative or predischarge mortality. Prenatal diagnosis was associated with increased odds of a scheduled delivery, birth before a gestational age of 39 weeks, and a decreased need for invasive respiratory support. Prenatal diagnosis of CHD was not associated with preoperative or predischarge mortality.