Division of Pediatric Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.
Division of Pediatric Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.
J Cardiol. 2022 Oct;80(4):344-350. doi: 10.1016/j.jjcc.2022.05.008. Epub 2022 Jun 17.
The frequency, mortality, and morbidity of very low birth weight (VLBW) infants with congenital heart disease (CHD) in Asian countries are limited. In addition, little is known about the risk factors of death in these infants.
A retrospective, multicenter cohort study was conducted. VLBW infants with CHD born between 2006 and 2010, and followed to 5 years of age, were included in the analysis. Multiple logistic regression analysis was performed to identify the risk factors of death.
Among 3247 VLBW infants, 126 various CHDs (3.9 %) were identified. The most common lesions were ventricular septal defect, tetralogy of Fallot (TOF), and coarctation of the aorta/interrupted aortic arch, in that order. The proportions of left-sided and right-sided outflow obstruction (TOF, pulmonary stenosis) were 15.1 % and 15.9 %, respectively. Trisomy 18 and trisomy 13 were present in 32 (25.4 %) of 126 VLBW infants with CHD. Nine patients were lost to follow-up. Overall, 45 patients (35.7 %) died up to 5 years of age. Serious CHD [odds ratio (OR), 19.2; 95 % confidential interval (CI), 3.94-93.11; p < 0.0001], sepsis (OR, 42.3; 95 % CI, 5.39-332.22; p < 0.0001), chromosomal /named anomalies (OR, 7.50; 95%CI, 2.09-26.94; p = 0.001), and no-invasive treatments (OR, 9.89; 95%CI, 2.28-42.91; p = 0.001) were associated with death. On excluding chromosomal anomalies, twelve of 71 patients (16.9 %) died, and only sepsis (OR, 35.5, 95%CI, 2.63-477.1; p = 0.0008) was an independent risk factor.
Trisomy 18 and trisomy 13 of chromosomal anomalies are frequently associated with VLBW infants with CHD. The mortality of VLBW infants with CHD is high, even when chromosomal anomalies are excluded. Sepsis has a significant impact on death in VLBW infants with CHD.
亚洲国家极低出生体重（VLBW）伴有先天性心脏病（CHD）婴儿的发病率、死亡率和发病率有限。此外，对于这些婴儿死亡的危险因素知之甚少。
这是一项回顾性、多中心队列研究。分析了 2006 年至 2010 年间出生的伴有 CHD 的 VLBW 婴儿，并随访至 5 岁。采用多因素 logistic 回归分析确定死亡的危险因素。
在 3247 例 VLBW 婴儿中，发现了 126 种不同的 CHD（3.9%）。最常见的病变依次为室间隔缺损、法洛四联症（TOF）和主动脉缩窄/主动脉弓中断。左心流出道梗阻（TOF、肺动脉瓣狭窄）和右心流出道梗阻的比例分别为 15.1%和 15.9%。32 例（25.4%）伴有 CHD 的 VLBW 婴儿存在 18 三体和 13 三体。9 例失访。总的来说，45 例（35.7%）患者在 5 岁时死亡。严重的 CHD[比值比（OR），19.2；95%置信区间（CI），3.94-93.11；p<0.0001]、败血症（OR，42.3；95%CI，5.39-332.22；p<0.0001）、染色体/命名异常（OR，7.50；95%CI，2.09-26.94；p=0.001）和非侵入性治疗（OR，9.89；95%CI，2.28-42.91；p=0.001）与死亡相关。排除染色体异常后，71 例患者中有 12 例（16.9%）死亡，只有败血症（OR，35.5，95%CI，2.63-477.1；p=0.0008）是独立的危险因素。
染色体异常中的 18 三体和 13 三体常与伴有 CHD 的 VLBW 婴儿有关。即使排除染色体异常，伴有 CHD 的 VLBW 婴儿的死亡率仍然很高。败血症对伴有 CHD 的 VLBW 婴儿的死亡有显著影响。
