Mellander Mats, Sunnegårdh Jan
Department of Paediatric Cardiology, Queen Silva Children's Hospital, Göteborg, Sweden.
Acta Paediatr. 2006 Apr;95(4):407-13. doi: 10.1080/08035250500541910.
To determine what proportion of newborns with critical heart defects are discharged undiagnosed from the maternity ward.
Data were retrieved retrospectively for infants born in our referral area from 1993 to 2001 and undergoing surgical or catheter-based intervention before 2 mo of age because of critical heart defects.
259 full-term infants had critical heart defects. Duct-dependent systemic circulation was present in 129, duct-dependent pulmonary circulation in 106, and 24 infants were not duct dependent but critically ill. In 51 infants (20%) the heart defect was not suspected before discharge from the maternity ward. Such late detection occurred more often in infants with duct-dependent systemic circulation (30%) and in children with defects that were not duct dependent (38%) than in children with duct-dependent pulmonary circulation (4%) (p<0.001). The proportion detected after discharge from the maternity ward increased from 13% in 1993-1995 and 21% in 1996-1998 to 26% in 1999-2001 (p<0.05).
Many infants with critical congenital heart defects are not diagnosed before discharge from the neonatal maternity ward. The proportion discharged undiagnosed has increased. Neonatal screening fails mainly in children with duct-dependent systemic circulation.
确定患有严重心脏缺陷的新生儿中有多大比例在产科病房出院时未被诊断出来。
回顾性检索1993年至2001年在我们转诊地区出生、因严重心脏缺陷在2月龄前接受手术或导管介入治疗的婴儿的数据。
259名足月儿患有严重心脏缺陷。129名存在依赖动脉导管的体循环，106名存在依赖动脉导管的肺循环，24名婴儿不依赖动脉导管但病情危重。51名婴儿（20%）在从产科病房出院前心脏缺陷未被怀疑。这种延迟诊断在依赖动脉导管的体循环婴儿（30%）和不依赖动脉导管的缺陷患儿（38%）中比在依赖动脉导管的肺循环患儿（4%）中更常见（p<0.001）。从产科病房出院后被诊断出的比例从1993 - 1995年的13%和1996 - 1998年的21%增加到1999 - 2001年的26%（p<0.05）。
许多患有严重先天性心脏缺陷的婴儿在新生儿产科病房出院前未被诊断出来。未被诊断而出院的比例有所增加。新生儿筛查主要在依赖动脉导管的体循环患儿中失败。
