Delayed diagnosis of congenital heart disease worsens preoperative condition and outcome of surgery in neonates
Delayed diagnosis of congenital heart disease worsens preoperative condition and outcome of surgery in neonates
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DOI：
10.1136/hrt.2005.078097
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发表时间：
2006-09-01
期刊：
影响因子：
5.7
通讯作者：
Bull, C.
中科院分区：
文献类型：
--
作者：
Brown, K. L.;Ridout, D. A.;Bull, C.
目的：为了评估是否新生儿先天性心脏病（CHD）的第一次承认的影响surgery after outcome.Methods：手术新生儿入院的第三心脏单位1999年3月和2002年2月之间的路线进行了回顾性分析，结果的危险因素。比较了三种最初识别CHD的途径：产前诊断、产后病房检测和出院回家后的表现。结果的措施是围手术期通气的死亡率和持续时间。结果：286名新生儿进行了心脏手术，中位通气时间为101小时，住院死亡率为12%。20%的人在产前、55%的人在产后病房和25%的人在出院回家后认识到CHD。多元回归分析，包括心脏诊断，相关问题和其他危险因素，表明严重的心血管损害入院心脏单位是显着相关的死亡率和延长通气。单独考虑，识别心脏病的途径并不影响死亡率或通气时间。然而，最初识别的途径确实影响了患者入院时的状况。心血管损害和终末器官功能障碍的可能性最小时，承认是产前和最常见的表现出院后到home.Conclusion：设置中，新生儿CHD是第一次承认有影响的术前条件，这反过来又影响术后进展和术后生存。优化的筛查程序和获得专业护理的机会将改善接受心脏手术的新生儿的预后。
Objectives: To assess whether the route by which neonatal congenital heart disease (CHD) is first recognised influences outcome after surgery.Methods: Surgical neonates admitted to a tertiary cardiac unit between March 1999 and February 2002 were retrospectively reviewed with analysis of risk factors for outcome. Three routes to initial recognition of CHD were compared: antenatal diagnosis, detection on the postnatal ward, and presentation after discharge to home. Outcome measures were mortality and duration of perioperative ventilation.Results: 286 neonates had cardiac surgery with a median duration of ventilation of 101 h and in-hospital mortality of 12%. Recognition of CHD was antenatal in 20%, on the postnatal ward in 55% and after discharge to home in 25%. Multiple regression analyses, including the cardiac diagnosis, associated problems and other risk factors, indicated that severe cardiovascular compromise on admission to the cardiac unit was significantly related to mortality and prolonged ventilation. Considered in isolation, the route to recognition of heart disease did not influence mortality or ventilation time. Route to initial recognition did, however, influence the patient's condition on admission to the cardiac unit. Cardiovascular compromise and end organ dysfunction were least likely when recognition was antenatal and most common when presentation followed discharge to home.Conclusion: The setting in which neonatal CHD is first recognised has an impact on preoperative condition, which in turn influences postoperative progress and survival after surgery. Optimal screening procedures and access to specialist care will improve outcome for neonates undergoing cardiac surgery.