de Sá Bittencourt Câmara Bastos Cecilia, Vale da Cruz Ludmilla, Hirano Arruda Moraes Lucas, Jornada Krebs Vera Lúcia, de Carvalho Werther Brunow
Department of Pediatrics, Faculty of Medicine of the University of São Paulo, Instituto da Criança e do Adolescente do Hospital das Clínicas, Av. Dr. Enéas de Carvalho Aguiar, 647, São Paulo, São Paulo, 05403-000, Brazil.
Neonatal Section, Pediatric Division, University Hospital of the University of Sao Paulo, São Paulo, Brazil.
Eur J Pediatr. 2025 Jun 20;184(7):430. doi: 10.1007/s00431-025-06274-7.
This systematic review and meta-analysis aimed to evaluate the clinical outcomes of cardiac surgery in neonates with trisomy 13 (T13) or trisomy 18 (T18) compared to those managed with palliative care. A literature search was conducted in PubMed® and EMBASE®, following PRISMA guidelines, and included five retrospective cohort studies (1627 patients). Outcomes analyzed included in-hospital mortality, survival at 12 months, length of stay (LOS), hospital discharge rates, and the need for mechanical ventilation. The meta-analysis showed that cardiac surgery significantly reduced the odds of in-hospital mortality (OR 0.12, CI 95% 0.03-0.42, p < 0.01), increased survival at 12 months (OR 19.77, CI 95% 5.12-76.36, p < 0.01), and improved discharge rates (OR 12.53, CI 95% 3.63-43.22, p < 0.01). However, limited data were available on quality of life and mechanical ventilation duration. Conclusion: Despite the positive impact of cardiac surgery on survival and discharge rates, the evidence remains low quality, as the included studies were primarily retrospective cohorts with moderate risk of bias. The findings highlight the importance of involving families in the decision-making process, given their differing perspectives on quality of life. Further high-quality studies, such as randomized controlled trials, are needed to provide stronger evidence on this topic.
本系统评价和荟萃分析旨在评估与接受姑息治疗的新生儿相比，患有13三体综合征（T13）或18三体综合征（T18）的新生儿心脏手术的临床结局。按照PRISMA指南在PubMed®和EMBASE®中进行文献检索，纳入了5项回顾性队列研究（1627例患者）。分析的结局包括住院死亡率、12个月生存率、住院时间（LOS）、出院率以及机械通气需求。荟萃分析表明，心脏手术显著降低了住院死亡率（比值比[OR]0.12，95%置信区间[CI]0.03 - 0.42，p < 0.01），提高了12个月生存率（OR 19.77，95% CI 5.12 - 76.36，p < 0.01），并改善了出院率（OR 12.53，95% CI 3.63 - 43.22，p < 0.01）。然而，关于生活质量和机械通气持续时间的数据有限。结论：尽管心脏手术对生存率和出院率有积极影响，但证据质量仍然较低，因为纳入的研究主要是回顾性队列，存在中度偏倚风险。鉴于家庭对生活质量的不同观点，研究结果凸显了让家庭参与决策过程的重要性。需要进一步开展高质量研究，如随机对照试验，以提供关于该主题的更有力证据。
