婴儿期先天性心脏病的表现：对常规检查的启示
Presentation of congenital heart disease in infancy: implications for routine examination.
作者信息
Wren C, Richmond S, Donaldson L
机构信息
Department of Paediatric Cardiology, Freeman Hospital, Newcastle upon Tyne.
出版信息
Arch Dis Child Fetal Neonatal Ed. 1999 Jan;80(1):F49-53. doi: 10.1136/fn.80.1.f49.
AIM
To investigate the performance of routine neonatal and 6 week examinations for detecting congenital heart disease.
METHODS
A retrospective review of findings on clinical examination was conducted of a cohort of live born infants with congenital heart disease in one health region in 1987-94.
RESULTS
Of 1590 babies with congenital heart disease, 523 (33%) presented before neonatal examination because of symptoms or non-cardiac abnormalities. 1061 underwent routine neonatal examination which was abnormal in 476 (45%), but only 170 were referred directly for diagnosis. Of 876 discharged with no diagnosis, 306 presented or died undiagnosed before 6 weeks. At 6 weeks 252 of 569 babies underwent a second routine examination which was abnormal in 164 (65%).
CONCLUSIONS
Routine neonatal examination fails to detect more than half of babies with heart disease; examination at 6 weeks misses one third. A normal examination does not exclude heart disease. Babies with murmurs at neonatal or 6 week examinations should be referred for early paediatric cardiological evaluation which will result either in a definitive diagnosis of congenital heart disease or in authoritative reassurance of normal cardiac anatomy and function.
目的
研究常规新生儿检查及6周龄检查对先天性心脏病的诊断效能。
方法
对1987年至1994年间某一健康区域出生的患有先天性心脏病的活产婴儿队列的临床检查结果进行回顾性分析。
结果
1590例患有先天性心脏病的婴儿中，523例（33%）因症状或非心脏异常在新生儿检查前就已就诊。1061例接受了常规新生儿检查，其中476例（45%）检查结果异常，但只有170例被直接转诊进行诊断。876例未确诊出院的婴儿中，306例在6周龄前未得到诊断就已出现症状或死亡。在6周龄时，569例婴儿中的252例接受了第二次常规检查，其中164例（65%）检查结果异常。
结论
常规新生儿检查未能检测出半数以上患有心脏病的婴儿；6周龄检查漏诊了三分之一。检查结果正常并不能排除心脏病。在新生儿期或6周龄检查时有杂音的婴儿应转诊至儿科心脏病专家处进行早期评估，这将有助于明确诊断先天性心脏病，或权威地确认心脏解剖结构和功能正常。
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