上海地区22089例新生儿先天性心脏病筛查与随访结果分析
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摘要
目的了解复旦大学附属妇产科医院分娩的新生儿先心病的流行病学资料,探讨可靠和易推广的先心病筛查方法。方法以2016年12月1日～2018年6月30日复旦大学附属妇产科医院出生的所有新生儿,以"心脏听诊+经皮血氧饱和度测定"为先心筛查指标,采取新生儿科医生和产科护士筛查,筛查阳性患儿经高年资新生儿科医生评估,转诊至定点儿科专科医院超声诊断、协作管理模式。结果 22 089例纳入先心病筛查中408人筛查阳性,其有183例确诊先心病,先心病患病率0.81%。先心病的主要构成种类以室间隔缺损为主要表现者74例,占40.4%;以房间隔缺损为主要表现者63例,占34.4%;以动脉导管未闭为主要表现者17例,占9.3%。先心患儿中早产儿、极低出生体重儿、低出生体重儿占全部出生新生儿的比例分别为13.1%、2.7%和9.8%,比例均高于非先心患儿(8.7%、0.9%、5.6%),差异有统计学意义。183例确诊先心患儿中有106例患儿缺损自然闭合或恢复正常(包括室间隔缺损46例,房间隔缺损43例,动脉导管未闭13例,肺动脉狭窄3例,轻度主动脉狭窄1例),17例患儿经手术矫正痊愈,1例死亡,25例失访。结论采用"心脏听诊+经皮血氧饱和度测定"作为新生儿先天性心脏病筛查指标能避免漏诊,提高先心病患儿检出率,该方法简单易行可靠,适合推广应用。大部分先心病患儿缺损自然闭合或恢复正常,经药物、介入、手术干预后预后较好。
Objective:To understand the epidemiological data of neonatal congenital heart disease(CHD)in the Obstetrics and Gynecology Hospital of Fudan University,and to explore a reliable and easy to popularize screening method for CHD.Methods:We analyzed newborn babies born between December 2016 to June 2018 in the Obstetrics and Gynecology Hospital of Fudan University using "heart auscultation and pulse oximetry screening" by pediatricians and obstetric nurses. Positive results of neonatal CHD screening were assessed by the high qualified pediatrician,transferred to the tertiary hospitals for ultrasonic diagnosis,and treatment if possible. Results:Among the 22 089 patients included in the screening of CHD,408 were screened positive,183 were diagnosed with CHD,and the prevalence of CHD was 0.81%. The main three categories of CHD were ventricular septal defect(74 cases,accounting for 40.4%)、atrial septal defect(63 cases,accounting for 34.4%)、patent ductus arteriosus(17 cases,accounting for 9.3%). Preterm,very low birth weight and low birth weight infants in CHD accounted for 13.1%,2.7% and 9.8%,which were higher than those of no-CHD infants(8.7%,0.9% and 5.6%,respectively),and the difference was statistically significant. Among the 183 CHD cases,106 cases had spontaneous closure or returned to normal(including 46 cases of ventricular septal defect,43 cases of atrial septal defect,13 cases of patent ductus arteriosus,3 cases of pulmonary artery stenosis,1 case of mild aortic stenosis),17 cases were cured after surgery,1 case was died,and 25 cases were lost to follow-up. Conclusion:As a screening index for CHD, "cardiac auscultation plus percutaneous oxygen saturation measurement" can avoid missed diagnosis and improve the detection rate of neonates with congenital heart disease. This method is simple and reliable,suitable for popularization and application. Most neonates with CHD had spontaneous closure or returned to normal,and had a good prognosis after drugs,interventions,surgery.
Objective:To understand the epidemiological data of neonatal congenital heart disease(CHD)in the Obstetrics and Gynecology Hospital of Fudan University,and to explore a reliable and easy to popularize screening method for CHD.Methods:We analyzed newborn babies born between December 2016 to June 2018 in the Obstetrics and Gynecology Hospital of Fudan University using "heart auscultation and pulse oximetry screening" by pediatricians and obstetric nurses. Positive results of neonatal CHD screening were assessed by the high qualified pediatrician,transferred to the tertiary hospitals for ultrasonic diagnosis,and treatment if possible. Results:Among the 22 089 patients included in the screening of CHD,408 were screened positive,183 were diagnosed with CHD,and the prevalence of CHD was 0.81%. The main three categories of CHD were ventricular septal defect(74 cases,accounting for 40.4%)、atrial septal defect(63 cases,accounting for 34.4%)、patent ductus arteriosus(17 cases,accounting for 9.3%). Preterm,very low birth weight and low birth weight infants in CHD accounted for 13.1%,2.7% and 9.8%,which were higher than those of no-CHD infants(8.7%,0.9% and 5.6%,respectively),and the difference was statistically significant. Among the 183 CHD cases,106 cases had spontaneous closure or returned to normal(including 46 cases of ventricular septal defect,43 cases of atrial septal defect,13 cases of patent ductus arteriosus,3 cases of pulmonary artery stenosis,1 case of mild aortic stenosis),17 cases were cured after surgery,1 case was died,and 25 cases were lost to follow-up. Conclusion:As a screening index for CHD, "cardiac auscultation plus percutaneous oxygen saturation measurement" can avoid missed diagnosis and improve the detection rate of neonates with congenital heart disease. This method is simple and reliable,suitable for popularization and application. Most neonates with CHD had spontaneous closure or returned to normal,and had a good prognosis after drugs,interventions,surgery.
引文
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[2]Zhao QM,Ma XJ,Ge XL,et al. Pulse oximetry with clinical assessment to screen for congenital heart disease in neonates in China:a prospective study[J]. Lancet,2014,384(9945):747-54.
[3]BestettiRB,Dellalibera-JovilianoR,LopesGS,etal.Determination of the Th1,Th2,Th17,and Treg cytokine profile in patients with chronic Chagas heart disease and systemic arterial hypertension[J]. Heart Vessels,2018 Jul 25.
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[6]胡煜,余静,管利荣,等.心脏杂音、呼吸困难和经皮氧饱和度测定在新生儿先天性心脏病筛查中的作用[J].临床儿科杂志,2014,32(1):26-29.
[7]Riede FT,W?rner C,D?hnert I,et al. Effectiveness of neonatal pulse oximetry screening for detection of critical congenital heart disease in daily clinical routine-results from a prospective multicenter study[J]. Eur J Pediatr,2010,169(8):975-81.
[8]Ewer AK. Pulse oximetry screening for critical congenital heart defects in newborn infants:should it be routine[J]. Arch Dis Child Fetal Neonatal Ed,2014,99(1):93-95.
[9]Matsubara H,Ogawa A.Treatment of idiopathic/hereditary pulmonary arterial hypertension[J]. J Cardiol,2014,64(4):243-9.
[10]杨旻,汪吉梅,钱蓓倩,等.73498例新生儿出生缺陷监测分析[J].临床儿科杂志,2015,33(6),553-557.
[11]Tanner K,Sabrine N,Wren C. Cardiovascular malformations among preterm infants[J]. Pediatrics,2005,116:E833-8.
[12]Zhao QM,Liu F,Wu L,et al. Prevalence of Congenital Heart Disease at Live Birth in China[J]. J Pediatr,2018.
[13]Archer JM,Yeager SB,Kenny MJ,et al. Distribution of and mortality from serious congenital heart disease in very low birth weight infants[J]. Pediatrics,2011,127:293-9.
[14]Wren C. Prematurity,low birth weight,and cardiovascular malformations[J]. Pediatrics,2011,127:385-6.
[15]孙晶,孙锟,陈笋.膜周部室间隔缺损大小及分流情况与自然闭合关系研究[J].中国实用儿科杂志,2013,28(2):129-131.
[16]Radzik D,Davignon A,van Doesburg N,et al. Predictive factors for spontaneous closure of atrial septal defects diagnosed in the first 3 months of life[J]. J Am Coll Cardiol,1993,223:851-3.
[2]Zhao QM,Ma XJ,Ge XL,et al. Pulse oximetry with clinical assessment to screen for congenital heart disease in neonates in China:a prospective study[J]. Lancet,2014,384(9945):747-54.
[3]BestettiRB,Dellalibera-JovilianoR,LopesGS,etal.Determination of the Th1,Th2,Th17,and Treg cytokine profile in patients with chronic Chagas heart disease and systemic arterial hypertension[J]. Heart Vessels,2018 Jul 25.
[4]Franklin RC,Jacobs JP,Krogmann ON,et al. Nomenclature for congenital and pediatric cardiac disease:historical perspectives and The International Pediatric and Congenital Cardiac Code[J].Cardiol Young,2008,18:70-80.
[5]Hu XJ,Ma XJ,Zhao QM,et al. Pulse Oximetry and Auscultation for Congenital Heart Disease Detection[J]. Pediatrics,2017 Sep 22.
[6]胡煜,余静,管利荣,等.心脏杂音、呼吸困难和经皮氧饱和度测定在新生儿先天性心脏病筛查中的作用[J].临床儿科杂志,2014,32(1):26-29.
[7]Riede FT,W?rner C,D?hnert I,et al. Effectiveness of neonatal pulse oximetry screening for detection of critical congenital heart disease in daily clinical routine-results from a prospective multicenter study[J]. Eur J Pediatr,2010,169(8):975-81.
[8]Ewer AK. Pulse oximetry screening for critical congenital heart defects in newborn infants:should it be routine[J]. Arch Dis Child Fetal Neonatal Ed,2014,99(1):93-95.
[9]Matsubara H,Ogawa A.Treatment of idiopathic/hereditary pulmonary arterial hypertension[J]. J Cardiol,2014,64(4):243-9.
[10]杨旻,汪吉梅,钱蓓倩,等.73498例新生儿出生缺陷监测分析[J].临床儿科杂志,2015,33(6),553-557.
[11]Tanner K,Sabrine N,Wren C. Cardiovascular malformations among preterm infants[J]. Pediatrics,2005,116:E833-8.
[12]Zhao QM,Liu F,Wu L,et al. Prevalence of Congenital Heart Disease at Live Birth in China[J]. J Pediatr,2018.
[13]Archer JM,Yeager SB,Kenny MJ,et al. Distribution of and mortality from serious congenital heart disease in very low birth weight infants[J]. Pediatrics,2011,127:293-9.
[14]Wren C. Prematurity,low birth weight,and cardiovascular malformations[J]. Pediatrics,2011,127:385-6.
[15]孙晶,孙锟,陈笋.膜周部室间隔缺损大小及分流情况与自然闭合关系研究[J].中国实用儿科杂志,2013,28(2):129-131.
[16]Radzik D,Davignon A,van Doesburg N,et al. Predictive factors for spontaneous closure of atrial septal defects diagnosed in the first 3 months of life[J]. J Am Coll Cardiol,1993,223:851-3.