影响先天性心脏病患儿神经发育随访率的因素。
Factors affecting rates of neurodevelopmental follow-up in infants with congenital heart disease.
作者信息
Monteiro Sonia, Serrano Faridis, Guffey Danielle, Lopez Keila N, De Thomas Estrella Mazarico, Voigt Robert G, Shekerdemian Lara, Morris Shaine A
机构信息
Baylor College of Medicine, Department of Pediatrics, Section of Developmental Pediatrics, Texas Children's Hospital, 6621 Fannin Street, Houston, TX, 77030, USA.
Baylor College of Medicine, Department of Pediatrics, Section of Critical Care Medicine, Texas Children's Hospital, 6651 Main Street, MC: E1420, Houston, TX, 77030, USA.
出版信息
Int J Cardiol Congenit Heart Dis. 2022 Sep 9;10:100419. doi: 10.1016/j.ijcchd.2022.100419. eCollection 2022 Dec.
BACKGROUND
Neurodevelopmental outcomes programs for children with congenital heart disease (CHD) support early identification and intervention for developmental impairments; however, not all eligible children attend such programs. The purpose of our study was to examine factors, including sociodemographic, associated with cardiac neurodevelopmental outcomes program attendance.
METHODS
Children with CHD born April 2013-April 2018 who underwent cardiac surgery before age 6 months were included. The primary outcome was at least one neurodevelopmental clinic visit, and secondary outcome was number of visits attended during the first two years of life. Predictor variables included maternal and infant characteristics, surgical data, geographic location of residence, and neighborhood-level socioeconomic metrics.
RESULTS
Of 730 eligible infants, median age at surgery was 13 days (IQR 7-44), and 37% were Hispanic, 45% were non-Hispanic White, and 10% were non-Hispanic Black. Twenty-three percent lived >200 miles from the institution. A total of 462 (63%) attended at least one visit. On multivariable analysis, factors associated with attending at least once were Hispanic ethnicity (if living <200 miles from the institution or Spanish-speaking), older maternal age, and shorter driving time. On multivariable analysis of the secondary outcome, factors associated with a greater number of visits were Hispanic ethnicity (if living <200 miles from the institution), older maternal age, shorter driving time, and private health insurance.
CONCLUSIONS
Our data demonstrate that Hispanic ethnicity and closer distance from the institution were associated with increased attendance in our neurodevelopmental program. Continued education on the importance of neurodevelopmental follow-up and making adaptations to current practices to reach all individuals with CHD will be important moving forward. Whether these higher rates of attendance improve neurodevelopmental outcomes for this specific population requires further research.
背景
先天性心脏病（CHD）患儿的神经发育结局项目支持对发育障碍进行早期识别和干预；然而，并非所有符合条件的儿童都参加此类项目。我们研究的目的是检查与心脏神经发育结局项目参与情况相关的因素，包括社会人口学因素。
方法
纳入2013年4月至2018年4月出生、6个月前接受心脏手术的CHD患儿。主要结局是至少进行一次神经发育门诊就诊，次要结局是生命最初两年内的就诊次数。预测变量包括母亲和婴儿的特征、手术数据、居住地理位置以及社区层面的社会经济指标。
结果
在730名符合条件的婴儿中，手术时的中位年龄为13天（四分位间距7 - 44），37%为西班牙裔，45%为非西班牙裔白人，10%为非西班牙裔黑人。23%的患儿居住在距离该机构200英里以上的地方。共有462名（63%）至少就诊过一次。在多变量分析中，与至少就诊一次相关的因素包括西班牙裔种族（如果居住在距离该机构200英里以内或讲西班牙语）、母亲年龄较大以及驾车时间较短。在对次要结局的多变量分析中，与就诊次数较多相关的因素包括西班牙裔种族（如果居住在距离该机构200英里以内）、母亲年龄较大、驾车时间较短以及拥有私人医疗保险。
结论
我们的数据表明，西班牙裔种族以及距离机构较近与我们的神经发育项目参与率增加相关。持续开展关于神经发育随访重要性的教育，并对当前做法进行调整以覆盖所有CHD患者，对未来而言将很重要。这些较高的参与率是否能改善这一特定人群的神经发育结局需要进一步研究。
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