Desai Jagdish, Aggarwal Sanjeev, Lipshultz Steven, Agarwal Prashant, Yigazu Paulos, Patel Riddhiben, Seals Samantha, Natarajan Girija
Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS; Division of Neonatology, Children's Hospital of Michigan, Wayne State University, Detroit, MI.
Division of Pediatric Cardiology, Children's Hospital of Michigan, Wayne State University, Detroit, MI.
J Pediatr. 2017 Dec;191:103-109.e4. doi: 10.1016/j.jpeds.2017.07.015. Epub 2017 Sep 28.
To evaluate short-term outcomes in infants born preterm with congenital heart defects (CHDs) and the factors associated with surgery, survival, and length of hospitalization in this population.
We analyzed data from infants born preterm (gestational age <37 weeks) enrolled in the multicenter Kids' Inpatient Database of the Healthcare Cost and Utilization Project who were admitted to the hospital within 30 days after birth. Infants with atrial septal defects were excluded.
Of 1 429 762 enrolled infants born preterm, 27 434 (2.0%) with CHDs were included. Overall survival to discharge was 90.5%; 74.0% among infants with critical CHDs and 45.7% among infants with hypoplastic left heart syndrome. Cardiac surgeries were performed in 12.2% of all infants born preterm. Rates of surgical intervention for infants with critical CHDs were lower for very low birth weight (≤1.5 kg) vs larger infants >1.5 kg (27% vs 44%), and only 6.3% of infants born with very low birth weight underwent surgeries in Risk-adjustment for Congenital Heart Surgery categories 4 or greater. Greater birth weight, left-sided lesions, care at children's hospitals, and absence of trisomies were associated with a greater likelihood of surgery. Birth weight <2 kg, nonwhite race, trisomy syndromes, prematurity-related morbidities, and Risk-adjustment for Congenital Heart Surgery category 4 or greater were independent predictors of mortality. Birth weight <2 kg, Risk-adjustment for Congenital Heart Surgery category, morbidities, and sidedness of lesion predicted length of stay.
The high survival rates of infants born preterm with CHDs suggests that a cautiously optimistic approach to surgery may be warranted in all but the most immature infants with the greatest-risk conditions.
评估患有先天性心脏病（CHD）的早产婴儿的短期预后，以及该人群中与手术、生存和住院时间相关的因素。
我们分析了医疗成本和利用项目多中心儿童住院数据库中早产（胎龄<37周）婴儿的数据，这些婴儿在出生后30天内入院。排除患有房间隔缺损的婴儿。
在1429762名登记的早产婴儿中，27434名（2.0%）患有先天性心脏病。出院时的总体生存率为90.5%；患有严重先天性心脏病的婴儿中为74.0%，患有左心发育不全综合征的婴儿中为45.7%。所有早产婴儿中有12.2%接受了心脏手术。出生体重极低（≤1.5 kg）的患有严重先天性心脏病的婴儿与出生体重>1.5 kg的较大婴儿相比，手术干预率较低（27%对44%），出生体重极低的婴儿中只有6.3%在先天性心脏手术风险调整类别4级或更高级别下接受了手术。出生体重较大、左侧病变、在儿童医院接受治疗以及无三体综合征与手术可能性较大相关。出生体重<2 kg、非白人种族、三体综合征、与早产相关的疾病以及先天性心脏手术风险调整类别4级或更高级别是死亡的独立预测因素。出生体重<2 kg、先天性心脏手术风险调整类别、疾病以及病变部位预测住院时间。
患有先天性心脏病的早产婴儿的高生存率表明，除了病情风险最大的最不成熟婴儿外，对所有婴儿采取谨慎乐观的手术方法可能是合理的。
