Gupta Neelam, Leven Louise, Stewart Michael, Cheung Michael, Patel Neil
Newborn Emergency Transport Services, Royal Children's Hospital, Melbourne, Australia,
Eur J Pediatr. 2014 May;173(5):655-60. doi: 10.1007/s00431-013-2231-0. Epub 2013 Dec 11.
Infants with significant congenital heart disease (CHD) typically require transport from their birth centre to a regional paediatric cardiac centre. Antenatal diagnosis of CHD allows early pre-emptive stabilisation, and is associated with improved early clinical status. However, the effect of antenatal diagnosis on the transport characteristics of infants with CHD has not been previously investigated. The aim of this study was to compare the transport characteristics of infants with antenatal and postnatal diagnosis of CHD. This study is a retrospective cohort study of all infants of ≤10 days and ≥34 weeks of gestation with CHD admitted to the Royal Children's Hospital, Melbourne (RCH) over 5 years. Demographic, diagnosis, and transport data were recorded. Cases of complex CHD were included in this study. Of 320 infants with complex CHD, 198 (62 %) had antenatal diagnosis (ANdx) and 122 (38 %) had postnatal diagnosis (PNdx). There was no significant difference in sex, birth weight, or gestation between ANdx and PNdx groups. Average age of referral was 15 vs. 53.4 h in ANdx vs. PNdx groups. Aggregate transfer distance in the ANdx group was 2216 km and in the PNdx group was 10,274 km (P < 0.0001). Of the infants, 39 % in the PNdx group required highest-acuity "time critical" transports compared to 6 % of ANdx infants (P = 0.0001). Conversely, only 11 % of the infants in the PNdx group had lowest acuity "non-urgent" transfers, compared to 24 % of ANdx infants (P = 0.003). PNdx was associated with significantly higher rates of invasive ventilation (36 vs 20 %; P = 0.01) and higher rates of inotrope use (19 vs. 9 %; P = 0.007) during transport.
Improved antenatal detection would allow for safer, less resource intense transfers of infants with CHD.
患有严重先天性心脏病（CHD）的婴儿通常需要从其出生中心转运至地区性儿科心脏中心。先天性心脏病的产前诊断可实现早期预防性稳定，并与改善早期临床状况相关。然而，产前诊断对患有先天性心脏病婴儿转运特征的影响此前尚未得到研究。本研究的目的是比较先天性心脏病产前诊断和产后诊断婴儿的转运特征。本研究是一项回顾性队列研究，研究对象为5年间入住墨尔本皇家儿童医院（RCH）的所有孕周≤10天且≥34周的患有先天性心脏病的婴儿。记录了人口统计学、诊断和转运数据。复杂先天性心脏病病例纳入本研究。在320例复杂先天性心脏病婴儿中，198例（62%）有产前诊断（ANdx），122例（38%）有产后诊断（PNdx）。ANdx组和PNdx组在性别、出生体重或孕周方面无显著差异。ANdx组和PNdx组的平均转诊年龄分别为15小时和53.4小时。ANdx组的总转运距离为2216公里，PNdx组为10274公里（P<0.0001）。在婴儿中，PNdx组39%的婴儿需要最高 acuity“时间关键型”转运，而ANdx组婴儿为6%（P = 0.0001）。相反，PNdx组只有11%的婴儿进行最低 acuity“非紧急”转运，而ANdx组为24%（P = 0.003）。PNdx与转运期间显著更高的有创通气率（36%对20%；P = 0.01）和更高的血管活性药物使用率（19%对9%；P = 0.007）相关。
改进产前检测将使患有先天性心脏病的婴儿能够更安全、资源消耗更少地转运。
