Stephenson Joseph J, Hook Jessica E, Beall Jonathan, Delany Dennis R, Buckley Jason R, Chowdhury Shahryar M, Steurer Martina A, Kavarana Minoo N, Costello John M
Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina College of Medicine, Charleston, USA.
Department of Public Health Sciences, Medical University of South Carolina College of Medicine, Charleston, USA.
Pediatr Cardiol. 2023 Apr;44(4):741-747. doi: 10.1007/s00246-023-03107-y. Epub 2023 Feb 7.
In infants undergoing truncus arteriosus (TA) repair, we sought to determine associations between fetal growth restrictions as measured by birth weight Z-score and early outcomes. We utilized the Pediatric Health Information System (PHIS) database to identify infants < 90 days old who underwent TA repair from 2004 to 2019. The primary exposure variable was birth weight Z-score, calculated based on gestational age at birth, gender, and birth weight. The primary outcome was postoperative hospital mortality. Secondary outcomes included major complications, prolonged postoperative length of hospital stay (LOS; > 30 days), and hospital readmission within 1 year. Generalized estimating equation (GEE) models were used to identify adjusted associations between birth weight Z-score, small for gestational age (SGA) status, and mortality and included were 1039 subjects. Median birth weight was 2960 g, gestational age at birth was 38 weeks, and birth weight Z-score was - 0.47. SGA was present in 21% of subjects. Hospital mortality occurred in 104 patients (10%). By multivariable analysis, lower birth weight Z-score was associated with higher hospital mortality [for each unit decrease in birth weight Z-score below - 1.0, adjusted OR 1.71 (95% CI 1.10-4.25)]. SGA status was associated with increased hospital mortality (adjusted OR 2.17; 95% CI 1.39-3.40). Birth weight Z-scores and SGA status were not significantly associated with occurrence of cardiac arrest, ECMO use, gastrostomy tube placement, tracheostomy, seizures, infection, prolonged postoperative LOS, or hospital readmission. In infants undergoing TA repair, lower birth weight Z-scores and SGA status were strongly associated with increased hospital mortality.
在接受共同动脉干（TA）修复术的婴儿中，我们试图确定以出生体重Z评分衡量的胎儿生长受限与早期结局之间的关联。我们利用儿科健康信息系统（PHIS）数据库，识别出2004年至2019年间接受TA修复术的90日龄以下婴儿。主要暴露变量是出生体重Z评分，根据出生时的孕周、性别和出生体重计算得出。主要结局是术后医院死亡率。次要结局包括主要并发症、术后住院时间延长（住院时间>30天）以及1年内再次入院。采用广义估计方程（GEE）模型来确定出生体重Z评分、小于胎龄（SGA）状态与死亡率之间的校正关联，纳入研究的有1039名受试者。出生体重中位数为2960g，出生时孕周为38周，出生体重Z评分为-0.47。21%的受试者存在SGA。104例患者（10%）发生医院死亡。通过多变量分析，较低的出生体重Z评分与较高的医院死亡率相关[出生体重Z评分每降低1个单位至低于-1.0，校正比值比（OR）为1.71（95%置信区间为1.10-4.25）]。SGA状态与医院死亡率增加相关（校正OR为2.17；95%置信区间为1.39-3.40）。出生体重Z评分和SGA状态与心脏骤停的发生、体外膜肺氧合（ECMO）的使用、胃造瘘管置入、气管切开术、癫痫发作、感染、术后住院时间延长或再次入院均无显著关联。在接受TA修复术的婴儿中，较低的出生体重Z评分和SGA状态与医院死亡率增加密切相关。
