Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany.
Department of Neonatology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Interact Cardiovasc Thorac Surg. 2021 Jan 1;32(1):130-136. doi: 10.1093/icvts/ivaa235.
Neonates with dextro-transposition of the great arteries (d-TGA) may experience rapid haemodynamic deterioration and profound hypoxaemia after birth. We report on d-TGA patients with severe acidosis, encephalopathy and their treatment with systemic hypothermia.
This study is a single-centre retrospective cohort analysis of newborns with d-TGA.
Ninety-five patients (gestational age ≥35 weeks) with d-TGA and intended arterial switch operation were included. Ten infants (10.5%) with umbilical arterial blood pH > 7.10 experienced profound acidosis (pH < 7.00) within the first 2 h of life. Six of these patients displayed signs of encephalopathy and received therapeutic hypothermia. Apgar scores at 5 min independently predicted the development of neonatal encephalopathy during postnatal transition (unit Odds Ratio 0.17, 95% confidence interval 0.06-0.49, P = 0.001). Infants treated with hypothermia had a more severe preoperative course and required more often mechanical ventilation (100% vs 35%, P = 0.003), treatment with inhaled nitric oxide (50% vs 2.4%, P = 0.002) and inotropic support (67% vs 3.5%, P < 0.001), as compared to non-acidotic controls. The median age at cardiac surgery was 12 (range 6-14) days in cooled infants and 8 (4-59) days in controls (P = 0.088). Postoperative morbidity and total duration of hospitalization were not increased in infants receiving preoperative hypothermia. Mortality in newborns with severe preoperative acidosis was zero.
Newborn infants with d-TGA have a substantial risk for profound acidosis during the first hours of life. Systemic hypothermia for encephalopathic patients may delay corrective surgery without compromising perioperative outcomes.
患有右旋大动脉转位（d-TGA）的新生儿在出生后可能会经历快速的血液动力学恶化和严重的低氧血症。我们报告了 d-TGA 患者出现严重酸中毒、脑病及其接受全身低温治疗的情况。
本研究是一项对 d-TGA 新生儿的单中心回顾性队列分析。
共纳入 95 例（胎龄≥35 周）有 d-TGA 且计划进行动脉导管转换手术的新生儿。10 例（10.5%）脐动脉血 pH 值＞7.10 的婴儿在生命的头 2 小时内出现严重酸中毒（pH 值＜7.00）。其中 6 例患儿出现脑病表现并接受了治疗性低温治疗。出生后过渡期新生儿脑病的发生与 Apgar 评分 5 分钟时独立预测相关（单位比值比 0.17，95%置信区间 0.06-0.49，P=0.001）。接受低温治疗的患儿术前病程更严重，更常需要机械通气（100% vs 35%，P=0.003）、吸入一氧化氮治疗（50% vs 2.4%，P=0.002）和正性肌力支持（67% vs 3.5%，P＜0.001），而非酸中毒对照组。接受低温治疗的患儿心脏手术的中位年龄为 12（6-14）天，对照组为 8（4-59）天（P=0.088）。接受术前低温治疗的患儿术后发病率和总住院时间均未增加。严重术前酸中毒的新生儿死亡率为零。
患有 d-TGA 的新生儿在生命的最初几小时内有发生严重酸中毒的巨大风险。对于出现脑病的患者，全身低温治疗可能会延迟矫正手术，但不会影响围手术期结局。
