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产前诊断严重先天性心脏病的比例仍然不足,存在显著的种族/民族和社会经济差异以及技术障碍。

Prenatal Diagnosis Rate of Critical Congenital Heart Disease Remains Inadequate with Significant Racial/Ethnic and Socioeconomic Disparities and Technical Barriers.

机构信息

Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, 3020 Children's Way, MC 5004, San Diego, CA, 92123, USA.

出版信息

Pediatr Cardiol. 2024 Dec;45(8):1713-1723. doi: 10.1007/s00246-023-03262-2. Epub 2023 Aug 30.

Abstract

Prenatal diagnosis (preDx) of critical congenital heart disease (CCHD) decreases neonatal morbidity and mortality. Obstetrical fetal cardiac imaging guidelines in 2013 aimed to increase preDx. The objectives of this study were to determine the contemporary preDx rate of CCHD and identify maternal-fetal factors and variations in prenatal care that may be potential barriers. This retrospective single center study evaluated maternal demographics and characteristics of infants with CCHD (requiring cardiac catheterization or surgical intervention before 6 months-old) between 2016 and 2019. 58% of the 339 infants with CCHD had preDx. Infants with preDx were more likely to have mothers ≥ 35 years-old (p = 0.028), family history of CHD (p = 0.017), health insurance (p = 0.002), or anatomic scan with perinatology (p < 0.001). Hispanic infants were less likely to have preDx (45.6%, p = 0.005). PreDx rates were higher in infants with extracardiac/genetic anomalies (p < 0.001) and significantly different between CCHD subtypes (76% for single ventricle, 51% for biventricular/four-chamber view, 59% for proximal outflow tract anomalies, and 48% for distal great artery anomalies; p = 0.024). In infants without preDx, 25% of their mothers had indication for, but did not undergo, fetal echocardiography. PreDx rates of CCHD remains inadequate across subtypes detectable by standard fetal cardiac screening views, particularly in uninsured and Hispanic communities.

摘要

产前诊断(preDx)可降低先天性心脏病(CCHD)新生儿的发病率和死亡率。2013 年的产科胎儿心脏成像指南旨在提高 preDx 率。本研究的目的是确定当前 CCHD 的 preDx 率,并确定可能是潜在障碍的母婴因素和产前护理的变化。这项回顾性单中心研究评估了 2016 年至 2019 年间患有 CCHD(需要在 6 个月前进行心导管检查或手术干预)的母亲的人口统计学特征和婴儿特征。339 例 CCHD 婴儿中有 58%接受了 preDx。有 preDx 的婴儿更有可能有年龄≥35 岁的母亲(p=0.028)、CHD 家族史(p=0.017)、健康保险(p=0.002)或与围产期医学相关的解剖扫描(p<0.001)。西班牙裔婴儿接受 preDx 的可能性较低(45.6%,p=0.005)。伴有心脏外/遗传异常的婴儿的 preDx 率较高(p<0.001),并且 CCHD 亚型之间存在显著差异(单心室为 76%,双心室/四腔心视图为 51%,近端流出道异常为 59%,大动脉异常为 48%;p=0.024)。在未进行 preDx 的婴儿中,其母亲中有 25%有但未接受胎儿超声心动图检查的指征。通过标准胎儿心脏筛查视图可检测到的 CCHD 各亚型的 preDx 率仍然不足,尤其是在未参保和西班牙裔社区。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0991/11442540/5deeb5dd9e7e/246_2023_3262_Fig1_HTML.jpg

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