Can echocardiographic screening in the early days of life detect critical congenital heart disease among apparently healthy newborns?
Can echocardiographic screening in the early days of life detect critical congenital heart disease among apparently healthy newborns?
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DOI：
10.1186/s12887-018-1344-z
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发表时间：
2018-11-19
期刊：
影响因子：
2.4
通讯作者：
Iijima S
中科院分区：
文献类型：
--
作者：
Kondo M;Ohishi A;Baba T;Fujita T;Iijima S
危重先天性心脏病（CCHD）的延误诊断会带来严重的死亡率、发病率和残疾风险。由于超声心动图通常用于诊断先天性心脏病（CHD），新生儿超声心动图检查可能有助于早期检测CCHD，并且比使用其他筛查方法具有更高的灵敏度。本研究旨在评估超声心动图筛查CCHD在三级保健中心的有效性。对2009年6月至2016年5月在滨松大学医院分娩的新生儿进行了回顾性图表审查。该研究纳入了由儿科心脏病专家进行早期超声心动图筛查（出生后5天内）的连续新生儿，出生时妊娠≥36周，出生体重≥2300 g，并在良好的婴儿保育室接受护理。排除新生儿重症监护室收治的新生儿，以及产前诊断为CHD和/或CHD临床症状或体征的新生儿。定义了四种CHD结局类别：危重、严重、具有临床意义和无临床意义。在研究期间，共有4082名活产新生儿分娩。3434例符合纳入标准并有完整超声心动图数据的新生儿中，104例（3.0%）被诊断为CHD。在这些患者中，没有人最初被诊断为患有危重或严重CHD。在95名继续接受心脏病专家随访的新生儿中，61名（64%）被确定为在出生后6个月内消退的非显著CHD。对排除的新生儿进行审查，发现9例危重或严重CHD;在这些新生儿中，6例在产前诊断，3例在出院前有CHD的一些临床体征。在我们的三级保健中心，超声心动图筛查的前5天内的生活并没有帮助提高CCHD的检出率在新生儿产前诊断或临床症状的CHD。超声心动图筛查可能与没有产前诊断或怀疑CHD的新生儿的假阳性率增加有关（缺陷导致临床上不显著的CHD）。
Delayed diagnosis of critical congenital heart disease (CCHD) carries a serious risk of mortality, morbidity, and handicap. As echocardiography is commonly used to diagnose congenital heart disease (CHD), echocardiographic investigations in newborns may be helpful in detecting CCHD earlier and with higher sensitivity than when using other screening methods. The present study aimed to evaluate the effectiveness of echocardiographic screening for CCHD in a tertiary care center. A retrospective chart review was conducted among newborns delivered at Hamamatsu University Hospital between June 2009 and May 2016. The study included consecutive newborns who underwent early echocardiographic screening (within the first 5 days of life) performed by pediatric cardiologists, were born at ≥36 weeks of gestation, had a birthweight ≥2300 g, and were cared for in the well-baby nursery. Newborns admitted to the neonatal intensive care unit, as well as those with prenatal diagnosis of CHD and/or clinical symptoms or signs of CHD were excluded. Four CHD outcome categories were defined: critical, serious, clinically significant, and clinically non-significant. A total of 4082 live newborns were delivered during the study period. Of 3434 newborns who met the inclusion criteria and had complete echocardiography data, 104 (3.0%) were diagnosed as having CHD. Among these, none was initially diagnosed as having critical or serious CHD. Of the 95 newborns who continued follow-up with a cardiologist, 61 (64%) were determined to have non-significant CHDs that resolved within 6 months of life. Review of excluded newborns revealed nine cases of critical or serious CHD; among these newborns, six were diagnosed prenatally and three had some clinical signs of CHD prior to hospital discharge. In our tertiary care center, echocardiography screening within the first 5 days of life did not help improve CCHD detection rate in newborns without prenatal diagnosis or clinical signs of CHD. Echocardiographic screening may be associated with increased rate of false-positives (defects resulting in clinically non-significant CHDs) in newborns without prenatal diagnosis or suspicion of CHD.
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DOI：
10.1136/fn.80.1.f43
发表时间：
1999-01-01
影响因子：
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作者：
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发表时间：
2013-06-01
期刊：
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
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