Effect of Fetal Growth on 1-Year Mortality in Neonates With Critical Congenital Heart Disease.
Effect of Fetal Growth on 1-Year Mortality in Neonates With Critical Congenital Heart Disease.
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DOI：
10.1161/jaha.118.009693
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发表时间：
2018-09-04
影响因子：
5.4
通讯作者：
Jelliffe-Pawlowski LL
中科院分区：
文献类型：
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作者：
Steurer MA;Baer RJ;Burke E;Peyvandi S;Oltman S;Chambers CD;Norton ME;Rand L;Rajagopal S;Ryckman KK;Feuer SK;Liang L;Paynter RA;McCarthy M;Moon-Grady AJ;Keller RL;Jelliffe-Pawlowski LL
患有严重先天性心脏病（CCHD）的婴儿更有可能小于胎龄（GA）。目前还不清楚这是如何影响死亡率的。作者分别研究了出生体重Z评分对早产（GA <37周）、早期（GA 37 - 38周）和足月（GA 39-42周）CCHD婴儿1年死亡率的影响。2007年至2012年在加州出生的22至42周患有CCHD和GA的活产婴儿被纳入分析。主要预测因子是出生体重的Z评分，主要结局是1年死亡率。采用多变量logistic回归。结果以调整后的优势比和95%置信区间（ci）表示。作者确定了6903名患有CCHD的婴儿。对于早产儿和足月儿，与参照组相比，只有出生体重< - 2的Z评分与死亡率增加相关（Z评分0-0.5，校正优势比分别为2.15 [95% CI, 1.1-4.21]和3.93 [95% CI, 2.32-6.68]）。相比之下，在早期足月婴儿中，与参照组相比，Z评分< - 2、- 2至- 1和- 1至- 0.5的校正优势比分别为3.42 （95% CI, 1.93-6.04）、1.78 （95% CI, 1.12-2.83）和2.03 （95% CI, 1.27-3.23）。GA似乎改变了出生体重Z评分对CCHD婴儿死亡率的影响。在早产儿和足月婴儿中，只有最严重的小患病婴儿（Z评分< - 2）的死亡风险增加，而在早足月婴儿中，风险扩展到轻度至中度小患病婴儿（Z评分< - 0.5）。这些信息有助于识别高危婴儿，并有助于手术计划。
Infants with critical congenital heart disease (CCHD) are more likely to be small for gestational age (GA). It is unclear how this affects mortality. The authors investigated the effect of birth weight Z score on 1‐year mortality separately in preterm (GA <37 weeks), early‐term (GA 37–38 weeks), and full‐term (GA 39–42 weeks) infants with CCHD. Live‐born infants with CCHD and GA 22 to 42 weeks born in California 2007–2012 were included in the analysis. The primary predictor was Z score for birth weight and the primary outcome was 1‐year mortality. Multivariable logistic regression was used. Results are presented as adjusted odds ratios and 95% confidence intervals (CIs). The authors identified 6903 infants with CCHD. For preterm and full‐term infants, only a Z score for birth weight <−2 was associated with increased mortality compared with the reference group (Z score 0–0.5, adjusted odds ratio, 2.15 [95% CI, 1.1–4.21] and adjusted odds ratio, 3.93 [95% CI, 2.32–6.68], respectively). In contrast, in early‐term infants, the adjusted odds ratios for Z scores <−2, −2 to −1, and −1 to −0.5 were 3.42 (95% CI, 1.93–6.04), 1.78 (95% CI, 1.12–2.83), and 2.03 (95% CI, 1.27–3.23), respectively, versus the reference group. GA seems to modify the effect of birth weight Z score on mortality in infants with CCHD. In preterm and full‐term infants, only the most severe small‐for‐GA infants (Z score <−2) were at increased risk for mortality, while, in early‐term infants, the risk extended to mild to moderate small‐for‐GA infants (Z score <−0.5). This information helps to identify high‐risk infants and is useful for surgical planning.