Derridj Neil, Ghanchi Ali, Bonnet Damien, Adnot Pauline, Rahshenas Makan, Salomon Laurent J, Cohen Jérémie F, Khoshnood Babak
Centre of Research in Epidemiology and Statistics (Inserm 1153, CRESS), Université Paris Cité, 75004 Paris, France.
M3C-Necker, National Reference Center for Complex Congenital Heart Diseases, APHP, Université Paris Cité, Hôpital Necker-Enfants Malades, CEDEX 15, 75743 Paris, France.
J Cardiovasc Dev Dis. 2023 Jan 27;10(2):47. doi: 10.3390/jcdd10020047.
Mortality outcomes of children with isolated neonatally operated congenital heart defects (CHDs) born with a low (LBW), moderately low (MLBW) or very-low birthweight (VLBW) remain ambiguous. We searched Medline and Embase (inception until October 2021) and included studies that evaluated early mortality. The risk of bias was assessed using the Critical Appraisal Skills Program cohort checklist. Meta-analysis involved random-effects models. We explored variability in mortality across birthweight subgroups, CHD types, and study designs. From 2035 reports, we included 23 studies in qualitative synthesis, and the meta-analysis included 11 studies (1658 CHD cases), divided into 30 subcohorts. The risk of bias was low in 4/11 studies included in the meta-analysis. Summary mortality before discharge or within one month after surgery was 37% (95%CI 27-47). Early mortality varied by birthweight (VLBW 56%, MLBW 15%, LBW 16%; = 0.003) and CHD types (hypoplastic left heart syndrome (HLHS) 50%, total anomalous pulmonary venous return (TAPVR) 47%, transposition of the great arteries (TGA) 34%, coarctation of the aorta (CoA) 16%; = 0.13). Mortality was higher in population-based studies (49% vs. 10%; = 0.006). One-third of infants born with neonatally operated isolated CHDs and LBW, MLBW, or VLBW died within 30 days after surgery. Mortality varied across infant and study characteristics. These results may help clinicians assess neonatal prognosis. PROSPERO registration CRD42020170289.
出生时低体重（LBW）、中度低体重（MLBW）或极低出生体重（VLBW）的单纯性新生儿期手术先天性心脏病（CHD）患儿的死亡率结果仍不明确。我们检索了Medline和Embase（从创刊至2021年10月），纳入了评估早期死亡率的研究。使用关键评估技能计划队列清单评估偏倚风险。荟萃分析采用随机效应模型。我们探讨了不同出生体重亚组、CHD类型和研究设计之间死亡率的差异。从2035篇报告中，我们纳入了23项研究进行定性综合分析，荟萃分析纳入了11项研究（1658例CHD病例），分为30个亚队列。荟萃分析纳入的11项研究中有4项偏倚风险较低。出院前或术后1个月内的总死亡率为37%（95%CI 27 - 47）。早期死亡率因出生体重（VLBW为56%，MLBW为15%，LBW为16%；P = 0.003）和CHD类型（左心发育不全综合征（HLHS）为50%，完全性肺静脉异位引流（TAPVR）为47%，大动脉转位（TGA）为34%，主动脉缩窄（CoA）为16%；P = 0.13）而异。基于人群的研究中的死亡率更高（49%对10%；P = 0.006）。出生时为低体重、中度低体重或极低出生体重且接受新生儿期手术的单纯性CHD患儿中有三分之一在术后30天内死亡。死亡率因婴儿和研究特征而异。这些结果可能有助于临床医生评估新生儿预后。PROSPERO注册号CRD42020170289。
