학술논문
Prevalence and Outcomes of Congenital Heart Disease in Very Low Birth Weight Preterm Infants: An Observational Study From the Brazilian Neonatal Network Database.
Document Type
Academic Journal
Author
Anderson D; Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil.; Aragon DC; Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil.; Gonçalves-Ferri WA; Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil.; Manso PH; Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil.; Leal G; Hospital das Clínicas, Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.; Krebs VLJ; Hospital das Clínicas, Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.; Caldas JPS; Departamento de Pediatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, São Paulo, Brazil.; Almeida JHCL; Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.; Ribeiro MAS; Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.; Silveira RC; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.; Duarte JLMB; Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.; Penido MG; Hospital das Clínicas, Universidade Federal de Minas Gerais, Minas Gerais, Brazil.; Ferreira DMLM; Hospital de Clínicas, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil.; Alves JMS Jr; Maternidade Escola Hilda Brandão, Faculdade de Ciências Médicas de Minas Gerais, Minas Gerais, Brazil.; Sakano KMK; Hospital Universitário da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.; Santos JPF; Hospital Estadual Sumaré, Sumaré, São Paulo, Brazil.; Gimenes CB; Hospital Geral de Pirajussara, São Paulo, Brazil.; Silva NMM; Hospital Estadual de Diadema, São Paulo, Brazil.; Melo FPG; Departamento de Pediatria e Cirurgia Pediátrica, Universidade Estadual de Londrina, Londrina, Brazil.; Venzon PS; Departamento de Pediatria, Universidade Federal do Paraná, Curitiba, Brazil.; Meneses J; Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil.; Marques PF; Hospital Universitário da Universidade Federal do Maranhão, São Luís, Brazil.; Rugolo LMSS; Departamento de Pediatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, São Paulo, Brazil.; Testoni D; Departamento de Pediatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.; Carmona F; Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil.
Source
Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 100954653 Publication Model: Print Cited Medium: Internet ISSN: 1529-7535 (Print) Linking ISSN: 15297535 NLM ISO Abbreviation: Pediatr Crit Care Med Subsets: MEDLINE
Subject
Language
English
ISSN
1529-7535
Abstract
Objectives: To evaluate the prevalence of congenital heart disease and their outcomes in a Brazilian cohort of very low birth weight preterm infants.
Design: Post hoc analysis of data from the Brazilian Neonatal Network database, complemented by retrospective data from medical charts and a cross-sectional survey.
Setting: Twenty public tertiary-care university hospitals.
Patients: A total of 13,955 newborns weighing from 401 to 1,499 g and between 22 and 36 weeks of gestational age, born from 2010 to 2017.
Interventions: None.
Measurements and Main Results: The prevalence of congenital heart disease was 2.45% (95% CI, 2.20-2.72%). In a multivariate regression analysis, risk factors associated with congenital heart disease were maternal diabetes (relative risk, 1.55; 95% CI, 1.11-2.20) and maternal age above 35 years (relative risk, 2.09; 95% CI, 1.73-2.51), whereas the protection factors were maternal hypertension (relative risk, 0.54; 95% CI, 0.43-0.69), congenital infection (relative risk, 0.45; 95% CI, 0.21-0.94), and multiple gestation (relative risk, 0.73; 95% CI, 0.55-0.97). The pooled standardized mortality ratio in patients with congenital heart disease was 2.48 (95% CI, 2.22-2.80), which was significantly higher than in patients without congenital heart disease (2.08; 95% CI, 2.03-2.13). However, in multiple log-binomial regression analyses, only the presence of major congenital anomaly, gestational age (< 29 wk; relative risk, 2.32; 95% CI, 2.13-2.52), and Score for Neonatal Acute Physiology and Perinatal Extension II (> 20; relative risk, 3.76; 95% CI, 3.41-4.14) were independently associated with death, whereas the effect of congenital heart disease was spotted only when a conditional inference tree approach was used.
Conclusions: The overall prevalence of congenital heart disease in this cohort of very low birth weight infants was higher and with higher mortality than in the general population of live births. The occurrence of a major congenital anomaly, gestational age (< 29 wk), and Score for Neonatal Acute Physiology and Perinatal Extension II (> 20) were significantly and independently associated with death, whereas the association of congenital heart disease and death was only evident when a major congenital anomaly was present.
Competing Interests: The Brazilian Neonatal Network received funding from Brazilian Ministry of Health (Ministério da Saúde do Brasil). Dr. Silva received support for article research from the National Institutes of Health. The remaining authors have disclosed that they do not have any potential conflicts of interest.
(Copyright © 2020 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)
Design: Post hoc analysis of data from the Brazilian Neonatal Network database, complemented by retrospective data from medical charts and a cross-sectional survey.
Setting: Twenty public tertiary-care university hospitals.
Patients: A total of 13,955 newborns weighing from 401 to 1,499 g and between 22 and 36 weeks of gestational age, born from 2010 to 2017.
Interventions: None.
Measurements and Main Results: The prevalence of congenital heart disease was 2.45% (95% CI, 2.20-2.72%). In a multivariate regression analysis, risk factors associated with congenital heart disease were maternal diabetes (relative risk, 1.55; 95% CI, 1.11-2.20) and maternal age above 35 years (relative risk, 2.09; 95% CI, 1.73-2.51), whereas the protection factors were maternal hypertension (relative risk, 0.54; 95% CI, 0.43-0.69), congenital infection (relative risk, 0.45; 95% CI, 0.21-0.94), and multiple gestation (relative risk, 0.73; 95% CI, 0.55-0.97). The pooled standardized mortality ratio in patients with congenital heart disease was 2.48 (95% CI, 2.22-2.80), which was significantly higher than in patients without congenital heart disease (2.08; 95% CI, 2.03-2.13). However, in multiple log-binomial regression analyses, only the presence of major congenital anomaly, gestational age (< 29 wk; relative risk, 2.32; 95% CI, 2.13-2.52), and Score for Neonatal Acute Physiology and Perinatal Extension II (> 20; relative risk, 3.76; 95% CI, 3.41-4.14) were independently associated with death, whereas the effect of congenital heart disease was spotted only when a conditional inference tree approach was used.
Conclusions: The overall prevalence of congenital heart disease in this cohort of very low birth weight infants was higher and with higher mortality than in the general population of live births. The occurrence of a major congenital anomaly, gestational age (< 29 wk), and Score for Neonatal Acute Physiology and Perinatal Extension II (> 20) were significantly and independently associated with death, whereas the association of congenital heart disease and death was only evident when a major congenital anomaly was present.
Competing Interests: The Brazilian Neonatal Network received funding from Brazilian Ministry of Health (Ministério da Saúde do Brasil). Dr. Silva received support for article research from the National Institutes of Health. The remaining authors have disclosed that they do not have any potential conflicts of interest.
(Copyright © 2020 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)