The Impact of Prenatal Diagnosis of Complex Congenital Heart Disease on Neonatal Outcomes
The Impact of Prenatal Diagnosis of Complex Congenital Heart Disease on Neonatal Outcomes
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DOI：
10.1007/s00246-010-9648-2
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发表时间：
2010-07-01
影响因子：
1.6
通讯作者：
Williams, Ismee A.
中科院分区：
文献类型：
--
作者：
Levey, Allison;Glickstein, Julie S.;Williams, Ismee A.
先天性心脏病（CHD）的产前诊断越来越普遍。然而，目前产前诊断对新生儿结局的影响尚不清楚。 2004 年 1 月至 2008 年 1 月期间，我们对在我们机构出院前接受先心病手术修复的婴儿进行了回顾性图表审查。记录产科和围手术期变量。在 439 名新生儿中，294 名（67%）在产前得到诊断 (PREdx)。与产后诊断 (POSTdx) 的婴儿相比，患有 PREdx 的婴儿的平均出生体重（3.0 +/- A 0.6 对比 3.1 +/- A 0.6 kg，p = 0.002）和胎龄（37.9 +/- A 2.1 对比 38.6 +/- A 2.4 周，p < 0.001）较低。严重病变更有可能发生 PREdx：单心室 (SV) 生理学新生儿（n = 130 名患者 [31.2%]）发生 PREdx 的几率增加（n = 113/130，比值比 [OR] 4.7；95% 置信区间 [CI] 2.7-8.2，p < 0.001）。 PREdx 与术前插管次数减少（OR 0.62；95% CI 0.42-0.95，p = 0.033）、抗生素使用（OR 0.23；95% CI 0.15-0.36，p < 0.001）、心导管插入术（OR 0.54；95% CI 0.34-0.85，p = 0.001）相关。与 POSTdx 婴儿相比，急诊手术（OR 0.18；95% CI 0.06-0.5，p < 0.001）。即使控制了病变严重程度，PREdx 组与 POSTdx 组的 APGAR 评分、术前 pH 值、手术天数、手术并发症、住院时间或总体死亡率也没有差异。尽管 PREdx 包括更严重的心脏病变，但 PREdx 与新生儿死亡率并不独立相关。 PREdx 与术前呼吸机使用、抗生素使用、心导管插入术和急诊手术减少等新生儿发病率降低显着相关。
Prenatal diagnosis of congenital heart disease (CHD) is increasingly common. However, the current impact of prenatal diagnosis on neonatal outcomes is unclear. Between January 2004 and January 2008, a retrospective chart review of infants who underwent surgical repair of CHD before discharge at our institution was conducted. Obstetric and perioperative variables were recorded. Of 439 neonates, 294 (67%) were diagnosed prenatally (PREdx). Infants with PREdx had a lower mean birth weight (3.0 +/- A 0.6 vs. 3.1 +/- A 0.6 kg, p = 0.002) and gestational age (37.9 +/- A 2.1 vs. 38.6 +/- A 2.4 wk, p < 0.001) than those with postnatal diagnosis (POSTdx). Severe lesions were more likely to be PREdx: Neonates with single-ventricle (SV) physiology (n = 130 patients [31.2%]) had increased odds of PREdx (n = 113/130, odds ratio [OR] 4.7; 95% confidence interval [CI] 2.7-8.2, p < 0.001). PREdx was associated with decreased preoperative intubation (OR 0.62; 95% CI 0.42-0.95, p = 0.033), administration of antibiotics (OR 0.23; 95% CI 0.15-0.36, p < 0.001), cardiac catheterization (OR 0.54; 95% CI 0.34-0.85, p = 0.01), and emergency surgery (OR 0.18; 95% CI 0.06-0.5, p < 0.001) compared with POSTdx infants. There was no difference in APGAR scores, preoperative pH, day of life of surgery, operative complications, hospital length of stay, or overall mortality in the PREdx versus POSTdx groups, even when controlling for lesion severity. PREdx was not independently associated with neonatal mortality, despite having included more severe cardiac lesions. PREdx was significantly associated with decreased neonatal morbidity in terms of decreased use of preoperative ventilator, administration of antibiotics, cardiac catheterization, and emergency surgery.