Yu Zhangbin, Xi Yangyang, Ding Wenxiao, Han Shuping, Cao Li, Zhu Chun, Wang Xuejie, Guo Xirong
Department of Pediatrics, Nanjing Maternal and Child Health Hospital, Nanjing Medical University, Nanjing, China.
Pediatr Int. 2011 Dec;53(6):1059-65. doi: 10.1111/j.1442-200X.2011.03450.x. Epub 2011 Oct 30.
The pre- and postnatal detection rate, incidence, clinical characteristics and outcomes of congenital heart disease (CHD) have been studied in developed countries for many years, but rarely have large-scale studies been reported in Chinese populations. The aim of the present study was to investigate the pre- and postnatal detection rates, incidence, clinical characteristics and outcomes of CHD in a Chinese hospital in order to improve the future screening and treatment of CHD.
Fetuses without risk factors for CHD were screened using basic cardiac ultrasound examination (BCUE). Fetuses with suspected cardiac malformation revealed by BCUE and fetuses with risk factors were screened using extended cardiac ultrasound examination. Outcomes recorded from fetal, neonatal and postmortem records over 4 years (2006-2009) included: therapeutic termination of pregnancy, spontaneous abortions or stillbirths, deaths at birth or in the neonatal period (before 28 days of age), and rate of birth and clinical characteristics of newborns.
A total of 34,071 fetuses were screened for CHD during a period of 4 years, of which 173 fetuses were screened for CHD using BCUE and 301 fetuses were screened using extended cardiac ultrasound examination. The incidence of fetal CHD increased from 1.1% in 2006 to 2.4% in 2009 (P < 0.05), yielding an overall incidence of 1.5% (523/34,071). Of the fetuses with CHD, 48.2% (252/523) died before 28 days of age (including intra-uterine death and termination of pregnancy), 51.8% (271/523) lived more than 28 days and the incidence of live newborns with CHD was 0.80% (271/34071).
The prevalence of CHD was quite common in this Chinese hospital. Detailed profiles of CHD suggest that, while training programs in obstetric screening at this hospital were beneficial, prenatal intervention, treatment and care of fetal CHD were inefficient and should be strengthened in China.
发达国家对先天性心脏病（CHD）的产前和产后检出率、发病率、临床特征及转归已进行了多年研究，但在中国人群中鲜有大规模研究报道。本研究旨在调查中国一家医院CHD的产前和产后检出率、发病率、临床特征及转归，以改善未来CHD的筛查和治疗。
对无CHD危险因素的胎儿采用基本心脏超声检查（BCUE）进行筛查。对BCUE检查发现可疑心脏畸形的胎儿及有危险因素的胎儿采用扩展心脏超声检查进行筛查。记录4年（2006 - 2009年）期间胎儿、新生儿及尸检记录的转归，包括：治疗性终止妊娠、自然流产或死产、出生时或新生儿期（28日龄前）死亡，以及新生儿的出生率和临床特征。
4年间共对34071例胎儿进行了CHD筛查，其中173例胎儿采用BCUE进行CHD筛查，301例胎儿采用扩展心脏超声检查进行筛查。胎儿CHD的发病率从2006年的1.1%上升至2009年的2.4%（P < 0.05），总体发病率为1.5%（523/34071）。在患有CHD的胎儿中，48.2%（252/523）在28日龄前死亡（包括宫内死亡和终止妊娠），51.8%（271/523）存活超过28天，患有CHD的活产新生儿发病率为0.80%（271/34071）。
CHD在中国这家医院较为常见。CHD的详细情况表明，虽然该医院的产科筛查培训项目有益，但胎儿CHD的产前干预、治疗和护理效率低下，在中国应予以加强。
