新生儿先天性心脏病危险因素分析

目的 探讨新生儿先天性心脏病(简称先心病)的类型及其可能的危险因素.方法 选择2004--2008年在本院出生的165例先心病患儿和同期出生的202例健康儿进行病例对照研究,了解先心病的类型,用单因素卡方检验和多元回归分析其可能的危险因素.结果 病例组中室间隔缺损87例,占52.7%,房间隔缺损17例,占10.3%,各类复杂先心痛共占29.7%,以完全性大血管转位最多见,其次为法洛四联症.孕早期感冒服药、糖尿病合并妊娠或妊娠期糖尿病、高龄产妇(＞35岁)、曾接触杀虫剂或类似药、母亲孕前或孕早期饮酒史、主被动吸烟史、妊娠期高血压疾病、孕早期接触室内装修物及油漆、先兆流产并服药及病毒感染均是先心病发生的相关危险因素(P<0.05).结论 应加强孕期健康教育,提高产前产后诊断水平.以早期防治先心病.     

新生儿先天性心脏病危险因素的病例对照研究

目的探讨新生儿先天性心脏病（简称＂先心病＂）的类型及其可能的危险因素,为制定预防措施提供参考依据。方法采用1∶1配对病例对照研究方法,选取2011年5月至2013年12月在本院新生儿科住院治疗的先心病患儿为病例组,无先心病的患儿为对照组,对两组患儿的亲生父母进行统一问卷调查。对所有研究因素进行单因素及多因素条件Logistic回归分析.筛选出与先心病发生相关的危险因素。结果研究期间本院新生儿科共收治3682例患儿,病例组和对照组各纳入139例。139例先心病患儿以室间隔缺损为主（34.5%）,其次为房间隔缺损＋室间隔缺损（14.4%）、房间隔缺损（10.8%）和室间隔缺损＋动脉导管未闭（10.1%）。母亲孕前及孕早期糖尿病（OR=7.321）、孕早期服用抗生素（OR=6.996）、孕早期被动吸烟（OR=4.948）、先心病家族史（OR=3.252）和孕早期上呼吸道感染（OR=3.461）均是先心病发生的相关危险因素（P〈0.05）。结论应加强孕期健康教育,提高产前产后诊断水平,以早期防治先心病,从而有效降低先心病的发病率。     

早产儿视网膜病发病情况及危险因素分析

目的探讨早产儿视网膜病(ROP)发病情况及影响ROP患病的危险因素。方法对2004-03—2005-12在北京大学第一医院新生儿监护室住院的胎龄≤34周和(或)出生体重≤2000g的早产儿在生后4~6周或校正胎龄至32周时进行眼底检查,并对相关危险因素进行分析。结果203例早产儿中有25例发生ROP,发生率为12.31%,7例出现阈值或阈值前病变需要治疗,占3.44%,Logistic回归分析表明小胎龄、低出生体重、母亲合并妊娠期糖尿病是发生ROP的危险因素,ROP组与正常眼底组在这三方面差异均有统计学意义(P<0.05)。结论小胎龄、低出生体重、母亲合并妊娠期糖尿病是发生ROP的危险因素。     

母孕期及新生儿期危险因素与儿童支气管哮喘的关系

目的分析儿童支气管哮喘与母孕期及新生儿期各因素的相关性,为疾病预防提供依据。方法对已确诊为支气管哮喘的162例患儿以及213名正常儿童进行回顾性调查,包括一般情况,母亲围孕期情况(产次、孕早期发热、妊娠高血压综合征、妊娠糖尿病、孕早期服药史),新生儿情况(出生时体表缺陷、窒息、胎盘粗糙、出生体质量、胎数、胎龄、剖宫产)。结果支气管哮喘儿童与对照儿童,母亲孕早期发热、妊娠高血压综合征、孕早期服药、胎盘粗糙、窒息、出生体质量、早产、剖宫产的差异均有统计学意义(P0.05);多因素Logistic回归分析发现,母亲孕早期发热(OR=9.43,95%CI:3.08~28.82)、胎盘粗糙(OR=2.15,95%CI:1.29~3.59)、早产(OR=5.16,95%CI:1.53~17.39)、剖宫产(OR=4.05,95%CI:2.40~6.86)均为儿童哮喘的独立危险因素。结论母亲孕早期发热、胎盘粗糙、早产、剖宫产可能与儿童支气管哮喘发生相关。     

孕早期重大负性生活事件与子代先天性心脏病病因的关联

目的 探讨孕早期重大负性生活事件与子代先天性心脏病(CHD)发生之间的关联.方法 查阅4-2-1体检筛查,并经市级以上医院确诊的CHD患儿资料,按12配对病例对照研究方法,采用面对面结构式访谈和电话访谈相结合的方式调查116例CHD患儿及232例健康对照儿童的父母人口统计学资料(包括孕前1 a的工作环境中是否接触到有毒有害物质等)、母亲既往不良妊娠史、孕期情况(包括孕早期重大负性生活事件、孕早期感冒史、孕早期发热史等环境因素暴露),运用单因素条件Logistic回归分析对研究因素初筛,然后对初选的可疑危险因素进行共线性诊断,排除变量间的共线性关系后用多因素条件Logistic逐步回归作进一步筛选.结果 母亲孕早期重大负性生活事件暴露、既往不良妊娠史、孕早期服用药物是子代发生CHD的可能危险因素,且孕早期重大负性生活事件暴露在所有危险因素中作用最强(OR=1.810).结论 加强孕早期母亲心理保健,控制或减少孕早期重大负性生活事件,可能降低子代CHD的发病危险.     

新生儿先天性心脏病监测与随访

目的探讨新生儿先天性心脏病(先心病)的发病情况和预后。方法(1)以彩色多普勒超声心动图配合尸检为主要诊断依据,对1992至1998年我院出生的31493例新生儿进行先心病发病情况前瞻性调查。(2)对1992至1995年出生的先心病患儿,随访3年。结果(1)以彩色多普勒超声心动图配合尸检,结合随访的修正诊断,检得先心病318例,患病率10.10‰。其中非青紫型255例,占80.2%,青紫型63例,占19.8%。室间隔缺损患病率5.14‰居首位。(2)318例先心病中新生儿期死亡35例,病死率11.0%,1992—1995年出生的167例先心病随访3年,死亡38例(22.8%),1岁内占94.7%,0～28d占68.4%。结论新生儿先心病发病率高,新生儿期是先心病死亡高峰年龄。     

新生儿先天性心脏病患病率的调查和孕妇增补叶酸的预防效果

目的 探讨新生儿先天性心脏病(先心病)患病率和妊娠初期增补叶酸的预防效果。方法 对1992年1月1日至1998年12月31日嘉兴市妇幼保健院出生的全部活婴31 470例,进行先心病前瞻性调查;调查1996年8月1日至1998年7月31日7 445例活产婴儿的母亲孕前1月至孕后3月内增补叶酸情况与先心病的发病关系;调查1994年6月1日至1998年12月31日出生的217例先心病的母亲妊娠初期增补叶酸情况。结果 31 470例新生儿中检得先心病312例,不包括单纯性动脉导管未闭和缺损直径小于5 mm的房间隔缺损(ASD)。其中彩色多普勒超声心动图(CDFM)诊断298例,尸检确诊14例,患病率9.91‰。室间隔缺损(VSD)居首位(51.6%),患病率5.12‰。重症复杂先心病新生儿期死亡32例,病死率10.3%。7 445例新生儿的母亲孕期增补叶酸情况与先心病患病率关系,增补叶酸组先心病患病率7.43‰,未补组患病率15.17‰。两组患病率差异有显著性意义,(P<0.01),相对危险度(RR)0.4898,归因危险度(AR)0.00774,归因危险比数(ARP)51.02%。重症复杂先心病患病率未补组为增补组的4.6倍。217例先心病中母亲孕初增补叶酸组占30.9%,未补组占69.1%。重症复杂畸形增补组7例占11.4%,未补组34例占22.7%。结论 应用CDFM是先心病检出率增加的主要原因。妊娠初期增补叶     

我国小儿室间隔缺损介入治疗的现状及存在问题

我国每年先天性心脏病(先心病)患病率为6.78%,新出生先心病患儿高达10万～15万例,其中单纯室间隔缺损(ventricular septal defect,VSD)约占先心病的20%.目前治疗包括传统的外科手术治疗、介入治疗以及近几年开展的内外科镶嵌治疗.     

中国新生儿先天性心脏病危险因素的Meta分析

目的探讨中国新生儿先天性心脏病(CHD)的主要危险因素,为CHD的预防提供参考依据。方法系统搜集2001~2016年研究中国新生儿CHD危险因素的病例对照研究,提取相关数据,按照NOS量表对纳入文献进行质量评价,敏感性分析采用不同模型分析同一资料,采用Egger's检验评估发表偏倚。结果共纳入17篇病例对照研究,其中病例组2 930例,对照组4 952例。Meta分析显示中国新生儿CHD主要危险因素为:孕母高龄(OR=2.649,95%CI:1.675~4.189)、感冒或发烧(OR=4.558,95%CI:2.901~7.162)、孕早期用药(OR=3.961,95%CI:2.816~5.573)、被动吸烟(OR=2.766,95%CI:1.982~3.859)、不良生育史(OR=2.992,95%CI:1.529~5.856)、接触噪声(OR=3.030,95%CI:1.476~6.217)、受到辐射(OR=2.363,95%CI:1.212~4.607)、居室新装修(OR=4.979,95%CI:3.240~7.653)、孕期糖尿病(OR=5.090,95%CI:3.132~8.274)、饲养宠物(OR=2.048,95%CI:1.385~3.029)。结论孕母高龄、感冒或发烧、孕早期用药、被动吸烟、不良生育史、接触噪声、受到辐射、居室新装修、孕期糖尿病、饲养宠物可能增加新生儿CHD的患病风险。     

综合医院新生儿先天性心脏病类型分析

本文对1987年1月～2001年12月入我院新生儿病房并经多普勒彩色超声心动图或尸体解剖诊断的类型分布.其中非青紫型先心病89例,占74.8%,青紫型30例,占25.2%.新生儿先心病常见类型的构成比依次为室间隔缺损(简称室缺)37.8%,动脉导管未闭26.9%,肺动脉瓣狭窄8.4%,法洛四联症6.7%,继发孔型房间隔缺损(简称房缺)5.9%,大动脉转位5.0%.38例室缺中,缺损直径≤3 mm 26例,占68.4%,4～5 mm 10例,≥6 mm 2例;27例动脉导管未闭中,导管内径2～3 mm21例,占77.8%,3.1～4 mm 6例;7例房缺中,缺损直径5～6 mm 5例,7～8 mm 2例.7例发生充血性心力衰竭(简称心衰),占5.9%,其中2例室缺于生后42d和49d死亡.伴随心外畸形6例,占5.0%,结论综合医院新生儿先心病的类型分布与专科医院不完全相同.新生儿先心病以室缺最多.非青紫型以室缺、动脉导管未闭的小型缺损多见,中型和大型室缺易发生肺炎和心衰,甚至引起死亡.青紫型以肺动脉瓣狭窄、法洛四联症、大动脉转位多见.本组较少伴随心外畸形.     

Prevalence and distribution of congenital heart diseases in Indre-et-Loire. Evaluation of prenatal diagnosis (1991-1994)]

Congenital heart diseases are the most frequent malformation at birth. New technologies have improved diagnosis procedures (echocardiography and Doppler). The aim of our study was to evaluate the prevalence of congenital heart diseases, their different types, and the detection rate of antenatal diagnosis. METHODS: A retrospective study was performed for all infants with congenital heart disease (CHD), born between January 1st 1991 and December 31st 1994, and for all fetuses which died after disruption of pregnancy, in Indre-et-Loire (a French country). In all cases, CHD diagnosis was confirmed with echocardiography and Doppler. RESULTS: CHD prevalence in newborns was 9.8% and 10.4% for the total population including dead fetal material. A high proportion of septal defects (64.8%) was observed with muscular, isolated and small forms (< 3 mm) in 70.2% of cases. The prevalence of great vessels transposition (0.15%), left ventricular hypoplasia (0.11%), and atrioventricular septal defect (0.11%), were lower than in previous studies. The performance of antenatal diagnosis was estimated at 40.5% for the four years; the prevalence of detectable CHD was only 1.4/1000. The atrioventricular septal defect was the most frequently detected. CONCLUSION: Relative high prevalence of congenital heart disease in this French county is due to the high level of small septal defects. Prevalence of detectable CHD remains low, which explains in part the difficulties of improving the antenatal diagnosis.     

Neurobehavioral abnormalities in newborns with congenital heart disease requiring open-heart surgery

In a prospective study, we evaluated the perioperative application of the Neonatal Intensive Care Unit Network Neurobehavioral Scale in a cohort of newborns with congenital heart disease (CHD). Infants with CHD were found to have suboptimal neurobehavioral performance compared with healthy infants without CHD, with particular vulnerability in the Regulation and Stress subscales.     

Prevalence of congenital heart disease assessed by echocardiography in 2067 consecutive newborns

Aim: There are discrepancies in the reported prevalence of congenital heart disease (CHD). This study prospectively evaluated the prevalence of CHD in consecutive newborns using echocardiographic screening. Methods: A cohort screening study was conducted in an unselected series of all live‐birth newborns. Two‐dimensional and colour Doppler echocardiography was performed at 0–4 days of life in 2067 consecutive neonates who were born at the Hamamatsu University Hospital, Japan, between May 2005 and April 2010. Results: There were 104 cases of CHD in the 2067 live births. Ventricular septal defect and patent ductus arteriosus were the most frequent cardiac abnormalities. The prevalence of newborns with CHD who had signs or symptoms of CHD and/or required invasive intervention was 21.3 per 1000 live births. However, 60 patients (29.0 per 1000 live births) with CHD were asymptomatic and did not need invasive intervention. The overall prevalence of CHD in this series was 50.3 per 1000 live births. Conclusion: This prospective study using echocardiography for all newborns shows a higher prevalence of CHD than almost all of the previous studies.     

The association between the congenital heart diseases and congenital anomalies of the kidney and the urinary tract in nonsyndromic children

Several congenital heart diseases (CHD) are present in children with congenital anomalies of the kidney and the urinary tract (CAKUT) in syndromic or nonsyndromic patterns. The purpose of this study was to identify nonsyndromic children with CAKUT who required echocardiographic evaluation and to find the prevalence of CHD in these patients. Retrospective chart review of nonsyndromic patients with CAKUT between 2012 and 2018 was conducted. Types of congenital anomalies of the kidney and urinary tract and echocardiogram reports of the patients, age, gender, prematurity, prenatal diagnosis of CAKUT, and family history were noted. Among 806 children with CAKUT, 135 patients underwent transthoracic echocardiographic evaluation and CHD was detected in 91 (11.2%). The most common type of CHD was secundum type atrial septal defect that was found in 73 (80.2%) patients. On the other hand, the most frequent types of congenital anomalies of the kidney and the urinary tract were isolated hydronephrosis and primary vesicoureteral reflux (61.4% and 12.8%, respectively). Our results showed that 75.8% of the patients with congenital heart diseases had isolated hydronephrosis. Finally, only 18 (2.2%) cases out of 806 patients that were evaluated via transthoracic echocardiography due to the clinical findings and family history had a CHD that required close (<6 months) follow-up. Congenital heart diseases that required close follow-up are rarely observed in nonsyndromic patients with CAKUT. Therefore, we suggest echocardiography should be performed in cases of clinical suspicion and family history rather than routinely in this patient group.     

Birth weight of children with congenital heart disease

Birth weights of 843 children with congenital heart disease (CHD) were compared to the respective data of a normal West German population. On average, the CHD group had significantly lower birth weights, but the weight deficit was far less pronounced than in previous studies. The decrease in birth weight was distinct only in children with tetralogy of Fallot and atrial septal defect. Compared to normal newborns, patients with CHD were more often small for gestational age (15.0%) or had a low (<2500 g) birth weight (8.6%). The prevalence of prematurity was not increased. Extracardiac malformations were not significantly more common in CHD patients, who were small for gestational age, than in CHD patients with normal birth weight.     

Multi-Tiered Analysis of Brain Injury in Neonates With Congenital Heart Disease

Early brain injury occurs in newborns with congenital heart disease (CHD) placing them at risk for impaired neurodevelopmental outcomes. Predictors for preoperative brain injury have not been well described in CHD newborns. This study aimed to analyze, retrospectively, brain magnetic resonance imaging (MRI) in a heterogeneous group of newborns who had CHD surgery during the first month of life using a detailed qualitative CHD MRI Injury Score, quantitative imaging assessments (regional apparent diffusion coefficient [ADC] values and brain volumes), and clinical characteristics. Seventy-three newborns who had CHD surgery at 8 ± 5 (mean ± SD) days of life and preoperative brain MRI were included; 38 also had postoperative MRI. Thirty-four (34 of 73, 47 %) had at least one type of preoperative brain injury, and 28 of 38 (74 %) had postoperative brain injury. The 5-min APGAR score was negatively associated with preoperative injury, but there was no difference between CHD types. Infants with intraparenchymal hemorrhage, deep gray matter injury, and/or watershed infarcts had the highest CHD MRI Injury Scores. ADC values and brain volumes were not different in infants with different CHD types or in those with and without brain injury. In a mixed group of CHD newborns, brain injury was found preoperatively on MRI in almost 50 %, and there were no significant baseline characteristic differences to predict this early brain injury except 5-min APGAR score. We conclude that all infants, regardless of CHD type, who require early surgery should be evaluated with MRI because they are all at high risk for brain injury.     

先天性心脏病患儿肺炎时H-FABP、NT-proBNP、cTnI对心功能状态评价的比较

目的比较血清心肌型脂肪酸结合蛋白(H-FABP)、末端脑钠肽原(NT-proBNP)及心肌肌钙蛋白I(cTnI)水平在患有肺炎的先天性心脏病(先心病)患儿中诊断心力衰竭时的应用价值。方法对患有肺炎的先心病患儿合并心力衰竭(A组)27例、患有肺炎的先心病患儿无心力衰竭(B组)23例、无先心病且心功能正常的肺炎患儿(C组)30例进行血清H-FABP、NT-proBNP、cTnI检测,观察和比较不同心功能状态下这些指标的变化。结果 A、B、C组cTnI、NT-ProBNP、H-FABP阳性率比较,差异均有统计学意义(P均<0.01);A组3项指标的阳性率均高于B组(P均<0.05)。A组心功能分级显示,随着心功能的恶化,cTnI的阳性率有增高趋势(P<0.05),而NT-ProBNP、H-FABP未显示出变化趋势(P>0.05)。结论随着心功能的恶化,cTnI阳性率增加,而NT-ProBNP、H-FABP在心力衰竭早期即表现出很高的阳性率,可作为诊断早期心肌缺血损伤的血清标志物。     

Combining Pulse Oximetry and Clinical Examination in Screening for Congenital Heart Disease

The objective of this study was to evaluate combined pulse oximetry and clinical examination as a screening method for congenital heart disease (CHD) in asymptomatic newborns. Asymptomatic newborns were screened for CHD using pulse oximetry and clinical examination before their discharge from the nursery. Oxygen saturation ≥94% was considered normal. Echocardiography was done for newborns with abnormal readings and for those with significant murmurs. Data concerning undetected cases were collected from the pediatric referral hospital. A total of 5211 cases were screened. Echocardiographic evaluations were done based on low pulse oximetry in five cases and on murmur detection in ten others. The sensitivity of the combined method of screening was 77%, whereas it was 31% for oximetry alone and 46% for clinical examination alone. Specificity was ∼100% for all methods. The positive predictive value of the combined tool was 66.7%. We conclude that combining pulse oximetry and clinical examination can enhance the clinician’s ability to detect life-threatening CHD in a timely manner. This screening method should become a part of the discharge plan for every newborn.     

Systemic levels following PGE1 inhalation in neonatal hypoxemic respiratory failure

AIM: To measure plasma prostaglandin E1 (PGE1) levels in newborns with hypoxemic respiratory failure (NHRF) following inhaled PGE1 (IPGE1), normal term newborns, and newborns with congenital heart disease (CHD) following intravenous PGE1. METHODS: Twenty newborns with NHRF received IPGE1 by jet nebulizer in doses of 25, 50, 150, and 300 ng/kg/min followed by weaning. Blood for PGE1 assay using enzyme immunoassay was available in eight neonates with NHRF, 10 normal newborns, and three neonates with CHD. RESULTS: There were no differences in PGE1 levels between cord arterial blood in normal newborns and baseline samples from newborns with NHRF. Oxygenation improved significantly following IPGE1 (p=0.024) in newborns with NHRF. No adverse events were identified. Although a reversible increase in PGE1 levels was detected following a dose of 50 ng/kg/min (p<0.05), there was no association between PGE1 levels and IPGE1 duration, PaO2, temperature, heart rate, and blood pressure. CONCLUSION: A reversible increase in mean PGE1 levels was demonstrable at low doses of IPGE1 in babies with NHRF using a sensitive assay, suggesting effective drug delivery. Levels did not increase further with increasing dose or duration of administration, suggesting local action in the lungs and a lack of systemic spillover due to extensive pulmonary metabolism offering pulmonary selectivity.