Klein Jennifer, Dwyer Gina, Donofrio Mary T, Krishnan Anita
Division of Cardiology, Children's National Hospital, Washington, DC.
Child Health Advocacy Institute, Children's National Hospital, Washington, DC.
J Pediatr. 2022 Jan;240:117-121. doi: 10.1016/j.jpeds.2021.08.080. Epub 2021 Sep 1.
To determine presence of spatial clustering or dispersion of pre and postnatally detected hypoplastic left heart syndrome (HLHS) and d-transposition of the great arteries (TGA) cases.
This retrospective study examined all patients with a prenatal or postnatal diagnosis of HLHS or TGA who had an initial visit or hospitalization at our tertiary care center over a 5-year period from 2012 to 2016 (n = 105). Using geographic information systems software, the nearest neighbor ratio (NNR) tool was used to determine whether statistically significant clustering or dispersion occurred.
Geographic clustering was observed among prenatally diagnosed pooled cases of HLHS and TGA and all total cases (NNR = 0.73 and 0.66, respectively), but not postnatally detected cases (NNR = 1.08). Notably, there was significant dispersion of postnatally detected TGA cases (NNR = 1.22) There was no pattern for prenatally detected TGA or HLHS when analyzed individually.
The spatial distribution of HLHS and TGA is not random; these conditions occur in geographic clusters. Clustering of all patients in the study population and dispersion of postnatal diagnosis of TGA represent opportunities for improved delivery of fetal cardiac care.
确定产前和产后检测出的左心发育不全综合征（HLHS）和大动脉转位（TGA）病例是否存在空间聚集或离散情况。
这项回顾性研究检查了2012年至2016年这5年期间在我们三级医疗中心首次就诊或住院的所有产前或产后诊断为HLHS或TGA的患者（n = 105）。使用地理信息系统软件，最近邻比率（NNR）工具用于确定是否发生具有统计学意义的聚集或离散。
在产前诊断的HLHS和TGA合并病例以及所有病例中均观察到地理聚集（NNR分别为0.73和0.66），但产后检测出的病例未观察到（NNR = 1.08）。值得注意的是，产后检测出的TGA病例存在显著离散（NNR = 1.22）。单独分析时，产前检测出的TGA或HLHS没有规律。
HLHS和TGA的空间分布并非随机；这些情况发生在地理集群中。研究人群中所有患者的聚集以及产后诊断TGA的离散代表了改善胎儿心脏护理的机会。
