Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, VIC, 3052, Australia.
Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
Pediatr Surg Int. 2021 Apr;37(4):503-509. doi: 10.1007/s00383-020-04795-w. Epub 2021 Jan 2.
Preoperative echocardiography is used routinely in neonates with esophageal atresia to identify patients in whom congenital cardiac disease will impact upon anesthetic and surgical decision-making. We aimed to determine the suitability of selective preoperative echocardiography.
We performed a single-center retrospective review of neonates with esophageal atresia over 6 years (2010-2015) at our tertiary pediatric institution. Data included preoperative clinical examination, chest x-ray, and echocardiography. Endpoints were cardiovascular, respiratory, radiological, and echocardiography findings. Selective strategies were assessed using sensitivity, specificity, positive predictive value, and negative predictive value.
We identified 115 neonates with esophageal atresia. All underwent preoperative echocardiography. Cardiac defects were identified in 49/115 (43%) (major 9/115, moderate 4/115). Sensitivity, specificity, positive predictive value, and negative predictive value of abnormal clinical and radiologic assessment for major and moderate cardiac defects were 92%, 25%, 13%, 96%; for clinical examination alone were 92%, 25%, 14%, 96%; for absence of murmur, cyanosis, and abnormal respiratory examination were 92%, 28%, 13%, 97%. Selective strategies reduce echocardiograms performed by 22%.
Selective strategies allow for identification of neonates with esophageal atresia who may have deferral of echocardiogram unill after surgery. Selection may improve timeliness of care and resource utilization, without compromising patient safety.
在患有食管闭锁的新生儿中，术前超声心动图被常规用于确定先天性心脏病将影响麻醉和手术决策的患者。我们旨在确定选择性术前超声心动图的适用性。
我们对我们的三级儿科机构的 6 年来（2010-2015 年）患有食管闭锁的新生儿进行了单中心回顾性研究。数据包括术前临床检查、胸部 X 光和超声心动图。终点为心血管、呼吸、影像学和超声心动图发现。使用敏感性、特异性、阳性预测值和阴性预测值评估选择性策略。
我们确定了 115 名患有食管闭锁的新生儿。所有患者均接受了术前超声心动图检查。在 115 例中发现了 49 例（43%）心脏缺陷（重大缺陷 9/115，中度缺陷 4/115）。异常临床和影像学评估对重大和中度心脏缺陷的敏感性、特异性、阳性预测值和阴性预测值分别为 92%、25%、13%和 96%；临床检查单独的敏感性、特异性、阳性预测值和阴性预测值分别为 92%、25%、14%和 96%；无杂音、发绀和异常呼吸检查的敏感性、特异性、阳性预测值和阴性预测值分别为 92%、28%、13%和 97%。选择性策略可减少 22%的超声心动图检查。
选择性策略可确定可能在手术后延迟进行超声心动图检查的食管闭锁新生儿。选择可能会提高及时性和资源利用效率，而不会影响患者安全。
