Xie Donghua, Wang Hua, Liu Zhiyu, Fang Junqun, Yang Tubao, Zhou Shujin, Wang Aihua, Qin Jiabi, Xiong Lili
Department of Information Management, Maternal and Children's Hospital of Hunan Province, Changsha, Hunan, China.
Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan, P.R. of China.
PLoS One. 2017 Jun 7;12(6):e0177229. doi: 10.1371/journal.pone.0177229. eCollection 2017.
To evaluate perinatal outcomes and congenital heart defect (CHD) prognosis in a non-selected population.
The population-based surveillance data used in this assessment of CHDs were based on birth defect surveillance data collected from 2010-2012 in Liuyang City, China. Infants living with CHDs were followed up for 5 years to determine their prognosis. Prevalence, prenatal diagnosis, perinatal outcomes, and total and type-specific prognosis data were assessed using SPSS 18.0.
In total, 190 CHD cases were identified among the 53313 included perinatal infants (PIs), indicating a CHD prevalence of 35.64 per 10000 PIs in this non-selected population. The five most frequently identified types of CHDs were ventricular septal defects (VSDs, 38.95%), atrial septal defects (ASDs, 15.79%), cardiomegaly (7.89%), tetralogy of Fallot (TOF, 5.79%), and atrioventricular septal defects (AVSDs, 5.26%). Of the 190 CHD cases, 110 (57.89%) were diagnosed prenatally, 30 (15.79%) were diagnosed with associated malformations, and 69 (36.32%) resulted in termination of pregnancy (TOP). Moreover, 15 (7.89%) PIs died within 7 days after delivery, and 42 (22.10%) died within 1 year. In contrast, 79 (41.58%) were still alive after 5 years. When TOP cases were included, the 5-year survival rate of PIs with prenatally detected CHDs was lower than that of PIs with postnatally detected CHDs (25.45% vs. 63.75%). The CHD subtype associated with the highest rate of infant (less than 1 year old) mortality was transposition of the great arteries (100%). The subtypes associated with higher 5-year survival rates were patent ductus arteriosus (80%), ASD (63.33%), VSD (52.70%) and AVSD (50%).
The rates of prenatal CHD detection and TOP were high in this study population, and the 5-year survival rate of PIs with CHDs was low. The government should strengthen efforts to educate pediatricians regarding this issue and provide financial assistance to improve the prognosis of infants living with CHDs, especially during the first year of life.
评估非选择性人群的围产期结局及先天性心脏病（CHD）预后。
本CHD评估中使用的基于人群的监测数据来自2010 - 2012年在中国浏阳市收集的出生缺陷监测数据。对患有CHD的婴儿进行了5年随访以确定其预后。使用SPSS 18.0评估患病率、产前诊断、围产期结局以及总体和特定类型的预后数据。
在纳入的53313例围产儿（PI）中，共识别出190例CHD病例，表明该非选择性人群中CHD患病率为每10000例PI中有35.64例。最常识别出的五种CHD类型为室间隔缺损（VSD，38.95%）、房间隔缺损（ASD，15.79%）、心脏肥大（7.89%）、法洛四联症（TOF，5.79%）和房室间隔缺损（AVSD，5.26%）。在190例CHD病例中，110例（57.89%）在产前被诊断，30例（15.79%）被诊断伴有相关畸形，69例（36.32%）导致终止妊娠（TOP）。此外，15例（7.89%）PI在出生后7天内死亡，42例（22.10%）在1年内死亡。相比之下，79例（41.58%）在5年后仍存活。当纳入TOP病例时，产前检测出CHD的PI的5年生存率低于产后检测出CHD的PI（25.45%对63.75%）。与婴儿（小于1岁）死亡率最高相关的CHD亚型是大动脉转位（100%）。与较高5年生存率相关的亚型是动脉导管未闭（80%）、ASD（63.33%）、VSD（52.70%）和AVSD（50%）。
本研究人群中产前CHD检测率和TOP率较高，患有CHD的PI的5年生存率较低。政府应加强对儿科医生关于此问题的教育，并提供财政援助以改善患有CHD的婴儿的预后，尤其是在生命的第一年。
