Pappas Athina, Shankaran Seetha, Hansen Nellie I, Bell Edward F, Stoll Barbara J, Laptook Abbot R, Walsh Michele C, Das Abhik, Bara Rebecca, Hale Ellen C, Newman Nancy S, Boghossian Nansi S, Murray Jeffrey C, Cotten C Michael, Adams-Chapman Ira, Hamrick Shannon, Higgins Rosemary D
Department of Pediatrics, Children's Hospital of Michigan and Hutzel Women's Hospital, Wayne State University, 3901 Beaubien, Detroit, MI 48201, USA.
Pediatr Cardiol. 2012 Dec;33(8):1415-26. doi: 10.1007/s00246-012-0375-8. Epub 2012 May 30.
Little is known about the outcomes of extremely low birth weight (ELBW) preterm infants with congenital heart defects (CHDs). The aim of this study was to assess the mortality, morbidity, and early childhood outcomes of ELBW infants with isolated CHD compared with infants with no congenital defects. Participants were 401-1,000 g infants cared for at National Institute of Child Health and Human Development Neonatal Research Network centers between January 1, 1998, and December 31, 2005. Neonatal morbidities and 18-22 months' corrected age outcomes were assessed. Neurodevelopmental impairment (NDI) was defined as moderate to severe cerebral palsy, Bayley II mental or psychomotor developmental index <70, bilateral blindness, or hearing impairment requiring aids. Poisson regression models were used to estimate relative risks for outcomes while adjusting for gestational age, small-for-gestational-age status, and other variables. Of 14,457 ELBW infants, 110 (0.8 %) had isolated CHD, and 13,887 (96 %) had no major birth defect. The most common CHD were septal defects, tetralogy of Fallot, pulmonary valve stenosis, and coarctation of the aorta. Infants with CHD experienced increased mortality (48 % compared with 35 % for infants with no birth defect) and poorer growth. Surprisingly, the adjusted risks of other short-term neonatal morbidities associated with prematurity were not significantly different. Fifty-seven (52 %) infants with CHD survived to 18-22 months' corrected age, and 49 (86 %) infants completed follow-up. A higher proportion of surviving infants with CHD were impaired compared with those without birth defects (57 vs. 38 %, p = 0.004). Risk of death or NDI was greater for ELBW infants with CHD, although 20 % of infants survived without NDI.
关于极低出生体重（ELBW）的先天性心脏病（CHD）早产儿的预后情况，人们了解甚少。本研究的目的是评估患有孤立性CHD的ELBW婴儿与无先天性缺陷婴儿相比的死亡率、发病率及幼儿期结局。研究对象为1998年1月1日至2005年12月31日期间在美国国立儿童健康与人类发展研究所新生儿研究网络中心接受护理的体重401 - 1000克的婴儿。评估了新生儿发病率及校正年龄至18 - 22个月时的结局。神经发育障碍（NDI）定义为中度至重度脑瘫、贝利婴幼儿发展量表第二版智力或心理运动发育指数<70、双眼失明或需要辅助器具的听力障碍。采用泊松回归模型估计结局的相对风险，同时对胎龄、小于胎龄状态及其他变量进行校正。在14457例ELBW婴儿中，110例（0.8%）患有孤立性CHD，13887例（96%）无重大出生缺陷。最常见的CHD类型为室间隔缺损、法洛四联症、肺动脉瓣狭窄及主动脉缩窄。患有CHD的婴儿死亡率增加（与无出生缺陷婴儿的35%相比为48%）且生长较差。令人惊讶的是，与早产相关的其他短期新生儿发病率的校正风险无显著差异。57例（52%）患有CHD的婴儿存活至校正年龄18 - 22个月，49例（86%）婴儿完成随访。与无出生缺陷的存活婴儿相比，患有CHD的存活婴儿中受损比例更高（57%对38%，p = 0.004）。患有CHD的ELBW婴儿死亡或发生NDI的风险更高，尽管20%的婴儿存活且无NDI。
