Liang Yi-Jing, Fang Jing-Xuan, Sun Yun-Xia, Feng Zhi-Chun, Liu Cai-Sheng, Zhang Xiao-Hui, Jian Min-Qiao, Zhong Jin, Wang Xi-Meng, Liu Yu-Mei, He Shao-Ru
Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Department of Child Healthcare, Affiliated Foshan Maternity and Child Healthcare Hospital, Southern Medical University, Foshan, China.
Cardiovasc Diagn Ther. 2022 Dec;12(6):868-879. doi: 10.21037/cdt-22-74.
The high death rate and medical costs of critical congenital heart disease (CCHD) in preterm infants has resulted in significant burdens on both countries and individuals. It is unclear how this affects the mortality of the integrated management model of prenatal diagnosis/postnatal treatment. This study explored the effects of the delivery classification scale for fetal heart and postnatal infants' CCHD on prenatal and postnatal integrated treatment strategies to improve the effectiveness of disease management in CCHD.
This study was a case-control study, which retrospectively analyzed the clinical data of 79 preterm infants (<37 weeks) who underwent prenatal diagnosis and postpartum treatment in Guangdong Provincial People' s Hospital (China) from June 2017 to June 2019. According to the diagnostic and exclusion criteria, the subjects were divided into prenatal and postpartum diagnostic groups. The clinical characteristics and survival outcomes of patients were collected and compared. The delivery classification scale was used for risk stratification and patient management.
Among the 79 patients included in this study, 48 (60.76%) were diagnosed prenatally, and 31 (39.24%) were diagnosed postpartum. The prenatal diagnosis group was born slightly earlier during the gestation period [35.00 (33.29-35.86) 35.57 (34.14-36.71) weeks, P<0.05], and their mothers were older (33.23±5.22 30.43±6.37 years, P<0.05). The difference in the admission age between the groups was statistically significant [0 (0-5.5) 7 (5-16) days, P<0.001]. The median survival time of the prenatal diagnosis group was higher than the postnatal diagnosis group [48 months (95% CI: 40.78-57.29) 39 months (95% CI: 34.41-44.32), P<0.05]. The 3-year survival rates of the classes I, II, and III were 92.31% (12/13), 59.09% (13/22), and 38.46% (5/13), respectively. The survival of class I as denoted in the delivery classification scale was better than classes II or III (class I II, P<0.05; class I III, P<0.05). Unexpectedly, the hospitalisation costs were lower and total in-hospital days were shorter in the postnatal diagnosis group.
The results indicated that the integrated management of a prenatal diagnosis/postnatal treatment approach in premature infants may be effective. Furthermore, the delivery classification scale has a particular prognostic value for CCHD. The authors anticipate that their management model will be able to contribute to the shift from a reactive monodisciplinary system to a proactive, multidisciplinary and dynamic management paradigm in premature infants with CCHD in the near future.
早产儿严重先天性心脏病（CCHD）的高死亡率和医疗成本给国家和个人都带来了沉重负担。目前尚不清楚这对产前诊断/产后治疗的综合管理模式的死亡率有何影响。本研究探讨胎儿心脏和产后婴儿CCHD的分娩分类量表对产前和产后综合治疗策略的影响，以提高CCHD疾病管理的有效性。
本研究为病例对照研究，回顾性分析了2017年6月至2019年6月在广东省人民医院（中国）接受产前诊断和产后治疗的79例早产儿（<37周）的临床资料。根据诊断和排除标准，将研究对象分为产前诊断组和产后诊断组。收集并比较患者的临床特征和生存结局。采用分娩分类量表进行风险分层和患者管理。
本研究纳入的79例患者中，48例（60.76%）为产前诊断，31例（39.24%）为产后诊断。产前诊断组的孕周稍早[35.00（33.29 - 35.86）对35.57（34.14 - 36.71）周，P<0.05]，其母亲年龄较大（33.23±5.22对30.43±6.37岁，P<0.05）。两组入院年龄差异有统计学意义[0（0 - 5.5）对7（5 -
16）天，P<0.001]。产前诊断组的中位生存时间高于产后诊断组[48个月（95%CI：40.78 - 57.29）对39个月（95%CI：34.41 - 44.32），P<0.05]。I、II和III级的3年生存率分别为92.31%（12/13）、59.09%（13/22）和38.46%（5/13）。分娩分类量表中I级的生存率优于II级或III级（I级对II级，P<0.05；I级对III级，P<0.05）。出乎意料的是，产后诊断组的住院费用较低，总住院天数较短。
结果表明，早产儿产前诊断/产后治疗的综合管理方法可能是有效的。此外，分娩分类量表对CCHD具有特殊的预后价值。作者预计，在不久的将来，他们的管理模式将有助于推动从被动的单学科系统向主动的、多学科的和动态的管理模式转变，用于患有CCHD的早产儿。
