Sochet Anthony A, Ayers Mark, Quezada Emilio, Braley Katherine, Leshko Jennifer, Amankwah Ernest K, Quintessenza James A, Jacobs Jeffrey P, Dadlani Gul
1 Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, United States of America.
2 Clinical and Translational Research Office, Johns Hopkins All Children's Hospital, Florida, United States of America.
Cardiol Young. 2013 Dec;23(6):896-904. doi: 10.1017/S1047951113001960.
Infants with critical congenital heart disease who require cardiothoracic surgical intervention may have significant post-operative mortality and morbidity. Infants who are small for gestational age <10th percentile with foetal growth restriction may have end-organ dysfunction that may predispose them to increased morbidity or mortality.
A single-institution retrospective review was performed in 230 infants with congenital heart disease who had cardiothoracic surgical intervention <60 days of age. Pre-, peri-, and post-operative morbidity and mortality markers were collected along with demographics and anthropometric measurements.
There were 230 infants, 57 (23.3%) small for gestational age and 173 (70.6%) appropriate for gestational age. No significant difference was noted in pre-operative markers - gestational age, age at surgery, corrected gestational age, Society for Thoracic Surgeons and European Association for Cardiothoracic Surgery mortality score; or post-operative factors - length of stay, ventilation days, arrhythmias, need for extracorporeal membrane oxygenation, vocal cord dysfunction, hearing loss; or end-organ dysfunction - gastro-intestinal, renal, central nervous system, or genetic. Small for gestational age infants were more likely to have failed vision tests (p = 0.006). Small for gestational age infants were more likely to have increased 30-day (p = 0.005) and discharge mortality (p = 0.035). Small for gestational age infants with normal birth weight (>2500 g) were also at increased risk of 30-day mortality compared with appropriate for gestational age infants (p = 0.045).
Small for gestational age infants with congenital heart disease who undergo cardiothoracic surgery <60 days of age have increased risk of mortality and failed vision screening. Assessment of foetal growth restriction as part of routine pre-operative screening may be beneficial.
需要心胸外科手术干预的患有严重先天性心脏病的婴儿术后可能有显著的死亡率和发病率。孕周小于第10百分位数且存在胎儿生长受限的小于胎龄儿可能存在终末器官功能障碍，这可能使他们更易出现发病率或死亡率增加的情况。
对230例60日龄内接受心胸外科手术干预的先天性心脏病婴儿进行了单机构回顾性研究。收集术前、术中和术后的发病率和死亡率指标以及人口统计学和人体测量数据。
共有230例婴儿，其中57例（23.3%）为小于胎龄儿，173例（70.6%）为适于胎龄儿。术前指标——孕周、手术时年龄、矫正孕周、胸外科医师协会和欧洲心胸外科协会死亡率评分；或术后因素——住院时间、通气天数、心律失常、体外膜肺氧合需求、声带功能障碍、听力丧失；或终末器官功能障碍——胃肠道、肾脏、中枢神经系统或遗传方面，均未发现显著差异。小于胎龄儿更有可能视力测试不通过（p = 0.006）。小于胎龄儿30天死亡率（p = 0.005）和出院时死亡率增加的可能性更大（p = 0.035）。出生体重正常（>2500 g）的小于胎龄儿与适于胎龄儿相比，30天死亡率风险也增加（p = 0.045）。
60日龄内接受心胸外科手术的患有先天性心脏病的小于胎龄儿死亡率增加且视力筛查不通过的风险更高。将胎儿生长受限评估作为常规术前筛查的一部分可能有益。
