McKenzie Jane M, Scodellaro Thomas, d'Udekem Yves, Chiletti Roberto, Butt Warwick, Namachivayam Siva P
1Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia. 2Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia. 3Cardiac Surgery, Royal Children's Hospital, Melbourne, VIC, Australia. 4Murdoch Children's Research Institute, Melbourne, VIC, Australia.
Pediatr Crit Care Med. 2017 Sep;18(9):876-883. doi: 10.1097/PCC.0000000000001249.
Several population-based studies have shown that gestational age 39-40 weeks at birth is associated with superior outcomes in various pediatric settings. A high proportion of births for neonates with congenital heart disease occur before 39 weeks. We aimed to assess the influence of late-term gestation (39-40 wk) on survival in neonates requiring extracorporeal life support following surgery for congenital heart disease.
Retrospective cohort study.
The Royal Children's Hospital, Melbourne, Australia.
Neonates requiring extracorporeal life support after cardiac surgery for congenital heart disease.
From 2005 to 2014, 110 neonates (10.5% of neonates undergoing cardiac surgery) required extracorporeal life support after cardiac surgery. Indications were failure to separate from cardiopulmonary bypass in 40 (36%), extracorporeal cardiopulmonary resuscitation in 48 (44%), progressive low cardiac output in 15 (14%), and other reasons in seven (6%). Extracorporeal life support duration was 94 hours (interquartile range, 53-135), and 54 (49%) underwent single ventricle repair. Gestation at birth (n [%]) was as follows: less than 37 weeks, 19 (17%); 37-38 weeks, 38 (35%); 39-40 weeks, 50 (45%); 41 weeks or more, 3 (3%). By multivariable analysis (controlling for age, era of extracorporeal life support 2005-2009 vs 2010-2014, single ventricle status and acute renal failure), gestational age of 39-40 weeks was associated with the lowest odds for intensive care mortality: using less than 37 weeks as referent, the adjusted odds ratio (95% CI) for 37-38 weeks was 0.41 (0.12-1.33); for 39-40 weeks, 0.27 (0.08-0.84); and for 41 weeks or more, 1.06 (0.07-14.7). Similar association was also seen in a subcohort of study neonates (n = 66) who were commenced on extracorporeal life support after admission to intensive care: using less than 37 weeks as referent, the adjusted odds ratio (95% CI) for 37-38 weeks was 0.52 (0.10-2.80) and for 39-40 weeks, 0.15 (0.03-0.81).
In this cohort of neonates requiring extracorporeal life support following cardiac surgery, 39-40 weeks of gestation at birth is associated with the best survival. The additional maturity gained by reaching a gestation of at least 39 weeks is likely to confer a survival advantage in this high-risk cohort.
多项基于人群的研究表明，出生时孕龄39 - 40周在各种儿科情况下都与更好的结局相关。患有先天性心脏病的新生儿中有很大比例在39周前出生。我们旨在评估足月妊娠（39 - 40周）对先天性心脏病手术后需要体外生命支持的新生儿生存的影响。
回顾性队列研究。
澳大利亚墨尔本皇家儿童医院。
先天性心脏病心脏手术后需要体外生命支持的新生儿。
2005年至2014年，110例新生儿（占接受心脏手术新生儿的10.5%）在心脏手术后需要体外生命支持。其原因分别为体外循环脱机失败40例（36%）、体外心肺复苏48例（44%）、进行性低心排血量15例（14%）、其他原因7例（6%）。体外生命支持持续时间为94小时（四分位间距为53 - 135小时），54例（49%）接受了单心室修复。出生时的孕周（n [%]）如下：小于37周，19例（17%）；37 - 38周，38例（35%）；39 - 40周，50例（45%）；41周及以上，3例（3%）。通过多变量分析（控制年龄、2005 - 2009年与2010 - 2014年体外生命支持时代、单心室状态和急性肾衰竭），孕龄39 - 40周与重症监护死亡率的最低比值相关：以小于37周为参照，37 - 38周的调整后比值比（95% CI）为0.41（0.12 - 1.33）；39 - 40周为0.27（0.08 - 0.84）；41周及以上为1.06（0.07 - 14.7）。在入住重症监护后开始接受体外生命支持的研究新生儿亚组（n = 66）中也观察到了类似的关联：以小于37周为参照，37 - 38周的调整后比值比（95% CI）为0.52（0.10 - 2.80），39 - 40周为0.15（0.03 - 0.81）。
在这组心脏手术后需要体外生命支持的新生儿中，出生时孕龄39 - 40周与最佳生存率相关。达到至少39周孕周所获得的额外成熟度可能会使这个高风险队列具有生存优势。
