胎儿超声心动图对新生儿重症监护病房先天性心脏病发病模式和结局的影响。

Impact of fetal echocardiography on trends in disease patterns and outcomes of congenital heart disease in a neonatal intensive care unit.

机构信息

Division of Neonatology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

出版信息

Neonatology. 2010 Jun;98(1):41-6. doi: 10.1159/000264673. Epub 2009 Dec 9.

DOI:10.1159/000264673

PMID:19996629

Abstract

BACKGROUND

Congenital heart disease (CHD) is the most common developmental malformation and the leading cause of neonatal mortality and morbidity. The introduction of fetal echocardiography has made prenatal diagnosis of CHD possible.

OBJECTIVE

This study was conducted to investigate the impact of fetal echocardiography on the changing disease patterns and outcomes of CHD.

METHODS

A retrospective analysis of data from infants with CHD admitted to the neonatal intensive care unit (NICU) of the Asan Medical Center during the time periods was performed. Period I (1994-1996) was considered representative of a period before the introduction of fetal echocardiography, while period II (2004-2006) represented a period of more extensive application of fetal echocardiography.

RESULTS

A total of 164 patients were admitted to the NICU during period I and 320 during period II. The number of infants prenatally diagnosed with CHD was 5 of 164 (3.0%) in period I and 219 of 320 (68.4%) in period II (p < 0.05). The overall accuracy of fetal diagnosis was approximately 92%. Of the 3 CHD categories, there was a greater proportion of infants with 'significant' heart disease in period II than I (47 vs. 32%; p < 0.05). In contrast, there was a smaller proportion of infants with 'simple' heart defects in period II than I (22 vs. 40%; p < 0.05). The proportion of infants with 'complex' heart disease was similar in both periods (28% in period I and 31% in period II). The 1-year survival rate of patients with CHD has improved remarkably with time (70.1% in period I to 88.8% in period II). Multivariate analysis showed prenatal diagnosis and planned delivery in a tertiary NICU are factors affecting CHD outcomes, especially when defects are 'complex' (p < 0.01).

CONCLUSION

Fetal echocardiography has resulted in an increased frequency of prenatal CHD diagnosis, has altered the disease patterns observed in the NICU, and has resulted in better 1-year outcomes.

摘要

背景

先天性心脏病（CHD）是最常见的发育畸形，也是新生儿死亡和发病的主要原因。胎儿超声心动图的引入使得 CHD 的产前诊断成为可能。

目的

本研究旨在探讨胎儿超声心动图对 CHD 疾病模式和结局变化的影响。

方法

对在 1994 年至 1996 年（第 I 期）和 2004 年至 2006 年（第 II 期）期间在首尔峨山医疗中心新生儿重症监护病房（NICU）住院的 CHD 婴儿进行回顾性数据分析。第 I 期被认为是在引入胎儿超声心动图之前的一个时期，而第 II 期则是胎儿超声心动图应用更为广泛的一个时期。

结果

第 I 期共有 164 名婴儿入住 NICU，第 II 期有 320 名。第 I 期有 5 名（3.0%）婴儿在产前被诊断为 CHD，第 II 期有 219 名（68.4%）婴儿（p<0.05）。胎儿诊断的总体准确率约为 92%。在 3 种 CHD 类型中，第 II 期有更多的“显著”心脏病婴儿（47%比 32%；p<0.05），而第 II 期有更少的“简单”心脏缺陷婴儿（22%比 40%；p<0.05）。两个时期“复杂”心脏病婴儿的比例相似（第 I 期为 28%，第 II 期为 31%）。随着时间的推移，CHD 患者的 1 年生存率显著提高（第 I 期为 70.1%，第 II 期为 88.8%）。多变量分析显示，产前诊断和在三级 NICU 中进行计划分娩是影响 CHD 结局的因素，尤其是当缺陷为“复杂”时（p<0.01）。