Division of Pediatric Cardiology, Department of Pediatrics, University of Florida, Gainesville, Florida 32610-0296, USA.
Pediatrics. 2011 Feb;127(2):293-9. doi: 10.1542/peds.2010-0418. Epub 2011 Jan 10.
To characterize serious congenital heart disease in very low birth weight (VLBW) infants (born at <1500 g or a gestational age of 22-29 weeks) in a large, international database.
We analyzed a database of 99 786 VLBW infants born or treated at 703 NICUs between calendar years 2006 and 2007. We defined serious congenital heart disease as 1 of 14 specific lesions or any other structural congenital heart disease that required surgical or medical treatment by initial hospital discharge or by the age of 1 year. We reviewed records for all infants with cardiac diagnoses and other genetic syndromes and associations to determine which had serious congenital heart disease. We excluded nonstructural disease as well as isolated and untreated atrial or ventricular septal defects. We determined the frequency of serious congenital heart disease, compared overall mortality rates of those with and without serious congenital heart disease, and determined the distribution of specific lesions and mortality for each diagnosis.
Of 99 786 VLBW infants studied, 893 had serious congenital heart disease (8.9 per 1000). The most common lesions were tetralogy of Fallot (n = 166 [18.6% of those with serious congenital heart disease]), aortic coarctation (n = 103 [11.5%]), complete atrioventricular canal (n = 81 [9.1%]), pulmonary atresia (n = 73 [8.2%]), and double-outlet right ventricle (n = 68 [7.6%]). The mortality rate of those with serious congenital heart disease was 44%, compared with 12.7% in those without serious congenital heart disease (P < .0001).
Serious congenital heart disease is probably more frequent in VLBW infants treated in NICUs than in the general live-born population, and the distribution reflects lesions associated with extracardiac malformations. VLBW infants with serious congenital heart disease have higher a mortality rate than those without, independent of other risk factors.
在一个大型国际数据库中描述极低出生体重儿（VLBW，出生体重<1500 克或胎龄 22-29 周）中严重先天性心脏病的特征。
我们分析了 2006 年至 2007 年期间在 703 家 NICU 出生或接受治疗的 99786 名 VLBW 婴儿的数据库。我们将严重先天性心脏病定义为 14 种特定病变之一，或任何其他结构性先天性心脏病，需要通过初始出院或 1 岁时进行手术或药物治疗。我们查阅了所有有心脏诊断和其他遗传综合征及关联的婴儿的记录，以确定哪些患有严重先天性心脏病。我们排除了非结构性疾病以及孤立性和未经治疗的房间隔或室间隔缺损。我们确定了严重先天性心脏病的发生频率，比较了有和无严重先天性心脏病的总体死亡率，并确定了每种诊断的特定病变和死亡率分布。
在研究的 99786 名 VLBW 婴儿中，有 893 名患有严重先天性心脏病（每 1000 名 8.9 例）。最常见的病变是法洛四联症（n=166[18.6%的严重先天性心脏病患儿]）、主动脉缩窄（n=103[11.5%]）、完全性房室管缺损（n=81[9.1%]）、肺动脉闭锁（n=73[8.2%]）和右心室双出口（n=68[7.6%]）。患有严重先天性心脏病的婴儿死亡率为 44%，而无严重先天性心脏病的婴儿死亡率为 12.7%（P<0.0001）。
在 NICU 接受治疗的 VLBW 婴儿中，严重先天性心脏病的发病率可能高于一般活产儿，且分布反映了与心脏外畸形相关的病变。患有严重先天性心脏病的 VLBW 婴儿的死亡率高于无严重先天性心脏病的婴儿，且独立于其他危险因素。
