Anderson Brett R, Blancha Eckels Victoria L, Crook Sarah, Duchon Jennifer M, Kalfa David, Bacha Emile A, Krishnamurthy Ganga
Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, 3959 Broadway, CH-2N, New York, NY, 10032, USA.
Columbia University College of Physicians and Surgeons, New York, NY, USA.
Pediatr Cardiol. 2020 Dec;41(8):1623-1631. doi: 10.1007/s00246-020-02420-0. Epub 2020 Jul 29.
The aims of this study were (1) to describe the additive risk of performing cardiac surgery in neonates born ≤ 2.0 kg, after accounting for the baseline risks of low birth weight, and (2) to describe the additive risk of being born ≤ 2.0 kg in neonates undergoing cardiac surgery. We used a risk difference analysis in a retrospective cohort, 2006-2016. Neonates born ≤ 2.0 kg undergoing congenital heart surgery during initial postnatal admission were included. Data were standardized alternatingly for birth weight and cardiac surgical risk using national population data to estimate the number of deaths expected had they not required cardiac surgery or were they of normal weight. Of 105 neonates ≤ 2 kg, median birth weight was 1.6 kg (IQR 1.3-1.8 kg). Median gestational age was 33 weeks (IQR 31-35 weeks). Observed operative mortality was 14.3%; 0% for neonates ≤ 1.0 kg (CI 0-33.6%), 20.6% for neonates > 1.0-1.5 kg (CI 8.7-37.9%), and 12.9% for neonates > 1.5-2.0 kg (CI 5.7-23.9%). Among neonates ≤ 2.0 kg not undergoing cardiac surgery, expected mortality was 4.8% (CI 1.6-10.8); cardiac surgery increased the risk of mortality 9.5% (CI 1.7-17.4%). Conversely, the expected risk for normal birth weight neonates undergoing cardiac surgery was 5.7% (CI 2.1-12.0%); low birth weight increased the risk of mortality 8.6% (CI 0.5-16.6%). To continue making advancements in cardiac surgery, we must understand that the rate of mortality observed in normal weight infants is not a realistic target and that, despite advances, the risk attributable to the surgery remains higher among low birth weight patients.
（1）在考虑低出生体重基线风险后，描述出生体重≤2.0kg的新生儿进行心脏手术的附加风险；（2）描述接受心脏手术的新生儿出生体重≤2.0kg的附加风险。我们在2006年至2016年的回顾性队列中进行了风险差异分析。纳入了出生体重≤2.0kg且在出生后首次住院期间接受先天性心脏手术的新生儿。使用国家人口数据对出生体重和心脏手术风险进行交替标准化，以估计如果他们不需要心脏手术或体重正常时预期的死亡人数。在105名体重≤2kg的新生儿中，中位出生体重为1.6kg（四分位间距1.3 - 1.8kg）。中位胎龄为33周（四分位间距31 - 35周）。观察到的手术死亡率为14.3%；体重≤1.0kg的新生儿为0%（可信区间0 - 33.6%），体重>1.0 - 1.5kg的新生儿为20.6%（可信区间8.7 - 37.9%），体重>1.5 - 2.0kg的新生儿为12.9%（可信区间5.7 - 23.9%）。在未接受心脏手术的体重≤2.0kg的新生儿中，预期死亡率为4.8%（可信区间1.6 - 10.8）；心脏手术使死亡风险增加了9.5%（可信区间1.7 - 17.4）。相反，正常出生体重的新生儿接受心脏手术的预期风险为5.7%（可信区间2.1 - 12.0）；低出生体重使死亡风险增加了8.6%（可信区间0.5 - 16.6）。为了在心脏手术方面持续取得进展，我们必须明白，正常体重婴儿中观察到的死亡率并非一个现实的目标，而且尽管取得了进展，但在低出生体重患者中，手术所致的风险仍然更高。
