Wei Daniel, Azen Colleen, Bhombal Shazia, Hastings Laura, Paquette Lisa
Division of Neonatal Medicine, Department of Pediatrics, Los Angeles County, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Pediatr Cardiol. 2015 Jan;36(1):1-7. doi: 10.1007/s00246-014-0954-y. Epub 2014 Jul 6.
Few studies have examined the role that small for gestational age (SGA) status plays in postoperative outcomes for low-birth-weight (LBW) infants with congenital heart disease (CHD). This study aimed to examine the effect of SGA status, gestational and chronologic age, and weight on differences in morbidities and mortalities during the immediate postoperative hospitalization period. The charts of infants with CHD weighing less than 2.5 kg who underwent operative repair during the neonatal period between 2004 and 2011 were reviewed. Infants with an isolated patent ductus arteriosus were excluded from the study. Data on hospital morbidities and mortality before discharge were collected. The study identified 136 LBW infants with a diagnosis of CHD. Among the 74 infants who underwent surgery and had complete chart records, the SGA infants had a higher gestational age at birth (36.8 vs. 32.3 weeks; p < 0.0001). The SGA and non-SGA infants did not differ in terms of survival to discharge or immediate postoperative outcomes. A lower weight at surgery was significantly associated with an increased risk of postoperative infection. In contradistinction, an older postnatal age at surgery was associated with an increased risk of preoperative infection (p < 0.0001). Additionally, lower gestational age at birth was associated with home oxygen use, higher tracheostomy rates, and discharge with a gastrostomy tube. Small for gestational age status played no protective role in the outcome for LBW infants after primary surgery for CHD. A weight of 2.4 kg or greater at the time of surgery was associated with lower rates of postoperative infections. Greater duration of time between birth and surgery was associated with a greater risk of preoperative infection. A gestational age of 32 weeks or more at birth was associated with decreased morbidities, which could influence obstetric management.
很少有研究探讨小于胎龄（SGA）状态在低出生体重（LBW）先天性心脏病（CHD）婴儿术后结局中所起的作用。本研究旨在探讨SGA状态、孕周和实际年龄以及体重对术后即刻住院期间发病率和死亡率差异的影响。回顾了2004年至2011年期间新生儿期接受手术修复的体重小于2.5 kg的CHD婴儿的病历。单纯动脉导管未闭的婴儿被排除在研究之外。收集了出院前的医院发病率和死亡率数据。该研究确定了136例诊断为CHD的低出生体重婴儿。在74例接受手术且有完整病历记录的婴儿中，SGA婴儿出生时的孕周较高（36.8周对32.3周；p<0.0001）。SGA和非SGA婴儿在出院存活率或术后即刻结局方面没有差异。手术时体重较低与术后感染风险增加显著相关。相反，手术时出生后年龄较大与术前感染风险增加相关（p<0.0001）。此外，出生时孕周较低与家庭吸氧、较高的气管造口术发生率以及带胃造口管出院有关。小于胎龄状态在CHD初次手术后的低出生体重婴儿结局中没有起到保护作用。手术时体重2.4 kg或更高与较低的术后感染率相关。出生与手术之间的时间间隔较长与术前感染风险较高相关。出生时孕周32周或以上与发病率降低相关，这可能会影响产科管理。
