Department of Pediatrics, University of California San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA.
California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA; Department of Pediatrics, University of California San Diego, La Jolla, CA; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA.
J Pediatr. 2021 Dec;239:110-116.e3. doi: 10.1016/j.jpeds.2021.08.039. Epub 2021 Aug 26.
To investigate the trends of 1-year mortality and neonatal morbidities in preterm infants with serious congenital heart disease (CHD).
This cohort study used a population-based administrative dataset of all liveborn infants of 26-36 weeks gestational age with serious CHD born in California between 2011 and 2017. We assessed 1-year mortality and major neonatal morbidities (ie, retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage grade >2, and periventricular leukomalacia) across the study period and compared these outcomes with those in infants without CHD.
We identified 1921 preterm infants with serious CHD. The relative risk (RR) of death decreased by 10.6% for each year of the study period (RR, 0.89; 95% CI, 0.84-0.95), and the RR of major neonatal morbidity increased by 8.3% for each year (RR, 1.08; 95% CI, 1.02-1.15). Compared with preterm neonates without any CHD (n = 234 522), the adjusted risk difference (ARD) for mortality was highest at 32 weeks of gestational age (9.7%; 95% CI, 8.3%-11.2%), that for major neonatal morbidity was highest at 28 weeks (21.9%; 95% CI, 17.0%-26.9%), and that for the combined outcome was highest at 30 weeks (26.7%; 95% CI, 23.3%-30.1%).
Mortality in preterm neonates with serious CHD decreased over the last decade, whereas major neonatal morbidities increased. Preterm infants with a gestational age of 28-32 weeks have the highest mortality or morbidity compared with their peers without CHD. These results support the need for specialized and focused medical neonatal care in preterm neonates with serious CHD.
研究患有严重先天性心脏病（CHD）的早产儿 1 年死亡率和新生儿发病率的趋势。
本队列研究使用了加利福尼亚州 2011 年至 2017 年间 26-36 周龄患有严重 CHD 的所有活产婴儿的基于人群的行政数据集。我们评估了研究期间的 1 年死亡率和主要新生儿发病率（即早产儿视网膜病变、支气管肺发育不良、坏死性小肠结肠炎、脑室出血程度>2 级和脑室周围白质软化），并将这些结果与无 CHD 的婴儿进行比较。
我们确定了 1921 名患有严重 CHD 的早产儿。研究期间，每增加 1 年，死亡的相对风险（RR）降低 10.6%（RR，0.89；95%CI，0.84-0.95），主要新生儿发病率的 RR 每增加 1 年增加 8.3%（RR，1.08；95%CI，1.02-1.15）。与没有任何 CHD 的早产儿（n=234522）相比，调整后的死亡率差异（ARD）在 32 周时最高（9.7%；95%CI，8.3%-11.2%），在 28 周时主要新生儿发病率最高（21.9%；95%CI，17.0%-26.9%），在合并结局时在 30 周时最高（26.7%；95%CI，23.3%-30.1%）。
过去十年中，患有严重 CHD 的早产儿死亡率下降，而新生儿主要发病率增加。与无 CHD 的同龄人相比，胎龄为 28-32 周的早产儿死亡率或发病率最高。这些结果支持在患有严重 CHD 的早产儿中提供专门和重点的新生儿医疗护理。
