Al Maddallah Walaa S, Bhat Yasser A, Al Mesned Abdulrahman, Al Qwaee Abdullah, Hassan Mohammad Ahmad, Al Akhfash Ali
Pediatric Cardiology, Prince Sultan Cardiac Center, Buraidah, SAU.
Pediatric Department, Sohag Faculty of Medicine, Sohag University, Sohag, EGY.
Cureus. 2023 Oct 14;15(10):e47011. doi: 10.7759/cureus.47011. eCollection 2023 Oct.
Congenital heart disease (CHD) is a common occurrence in live births, with some exhibiting critical congenital heart disease; therefore, cardiology services should be available around the clock to ensure timely diagnosis and management. This study aims to describe the workload and the need for pediatric cardiac services in a maternity hospital for newborn referrals. Moreover, the study describes the indications for neonatal cardiology consultations.
The prospective cohort study was conducted over four months, from January to April 2022, in the Prince Sultan Cardiac Center Al Qassim region of Saudi Arabia. Prince Sultan Cardiac Center's pediatric cardiology department provides cardiac services to the Maternity and Children Hospital Buraidah Al Qassim. Out of the total 2,606 live births during the study period, the cardiology team evaluated 352 neonates. Neonates less than 30 days of age who were born in the maternity hospital were enrolled in the study. The outborn babies referred from other centers as suspected congenital heart disease for whom a cardiac evaluation was done were excluded. In addition, babies assessed in the emergency room and born elsewhere were excluded. Only new consultations have been considered, excluding follow-up consultations.
Data about patients' demographic, clinical and echocardiographic findings were recorded on Google Forms and converted to a Google spreadsheet. The Google spreadsheet's inbuilt statistical software was used for analysis. Categorical data were presented as percentages, and numerical data as median and range.
The cardiology team evaluated 352 neonates from 2,606 live births over four months, accounting for 13.5 per 100 live births. The median weight was 2.8 kilograms, with a 0.5-4.3 kilogram range. Males comprised 187 (53%), and females comprised 165 (47%). Moreover, full-term, preterm, and post-term accounted for 236 (67%), 113 (32%), and 3 (0.8%) of patients, respectively. The common indications for neonatal cardiac referral were respiratory distress 60 (17%), infants born to diabetic mothers 50 (14%), abnormal fetal echocardiogram 49 (13.9%), family history of abortion or neonatal death 31 (8.8%), and congenital anomalies 30 (8.5%). Systolic murmur was the commonest clinical finding that prompted cardiology referrals 82 (23.2%), followed by desaturation 38 (10.7%) and dysmorphic features 31 (8.8%). Among the congenital cardiac defects, an isolated atrial septal defect (ASD) was seen in 66 (18.5%), isolated patent ductus arteriosus in 50 (14.2%), and ventricular septal defect in 21 (5.9%). Moreover, 13 (4.4%) lesions were critical CHDs. Finally, 27 (7.6%) had a diagnosis of pulmonary hypertension.
Knowing the burden of neonatal cardiac assessment on pediatric cardiology services in any maternity center may help the healthcare authorities to allocate resources and optimize the delivery of cardiac services among the neonatal population. Properly allocating pediatric cardiologists to the needed centers may optimize neonatal cardiac services. Moreover, it may decide on the number of pediatric cardiologists that need to be trained each year to meet the requirements of neonatal cardiac services.
先天性心脏病（CHD）在活产婴儿中很常见，有些表现为严重先天性心脏病；因此，心脏科服务应全天候提供，以确保及时诊断和治疗。本研究旨在描述一家妇产医院新生儿转诊的儿科心脏服务工作量及需求。此外，该研究还描述了新生儿心脏科会诊的指征。
前瞻性队列研究于2022年1月至4月在沙特阿拉伯卡西姆地区的苏丹王子心脏中心进行了四个月。苏丹王子心脏中心的儿科心脏科为布赖代卡西姆妇产儿童医院提供心脏服务。在研究期间的2606例活产婴儿中，心脏科团队评估了352例新生儿。研究纳入了在妇产医院出生且年龄小于30天的新生儿。排除从其他中心转诊来且疑似先天性心脏病并已进行心脏评估的外院出生婴儿。此外，排除在急诊室评估且在其他地方出生的婴儿。仅考虑新的会诊，排除随访会诊。
关于患者人口统计学、临床和超声心动图检查结果的数据记录在谷歌表格中，并转换为谷歌电子表格。使用谷歌电子表格内置的统计软件进行分析。分类数据以百分比表示，数值数据以中位数和范围表示。
心脏科团队在四个月内从2606例活产婴儿中评估了352例新生儿，占每100例活产婴儿中的13.5例。中位数体重为2.8千克，范围为0.5 - 4.3千克。男性187例（53%），女性165例（47%）。此外，足月、早产和过期产分别占患者的236例（67%）、113例（32%）和3例（0.8%）。新生儿心脏转诊的常见指征为呼吸窘迫60例（17%）、糖尿病母亲所生婴儿50例（14%）、胎儿超声心动图异常49例（13.9%）、流产或新生儿死亡家族史31例（8.8%）以及先天性畸形30例（8.5%）。收缩期杂音是促使心脏科转诊的最常见临床发现，有82例（23.2%），其次是血氧饱和度降低38例（10.7%）和畸形特征31例（8.8%）。在先天性心脏缺陷中，孤立性房间隔缺损（ASD）66例（18.5%），孤立性动脉导管未闭50例（14.2%），室间隔缺损21例（5.9%）。此外，13例（4.4%）病变为严重先天性心脏病。最后，27例（7.6%）诊断为肺动脉高压。
了解任何妇产中心儿科心脏服务中新生儿心脏评估的负担，可能有助于卫生当局分配资源并优化新生儿群体的心脏服务提供。将儿科心脏病专家合理分配到所需中心可优化新生儿心脏服务。此外，这可能决定每年需要培训的儿科心脏病专家数量，以满足新生儿心脏服务的需求。
