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Kritik konjenital kalp hastalığı olan yenidoğanların nakil sonuçlarının ameliyat süresi ve mortalite oranlarına etkisi

Yıl 2024, Cilt: 49 Sayı: 1, 62 - 70, 29.03.2024
https://doi.org/10.17826/cumj.1379435

Öz

Amaç: Kritik konjenital kalp hastalığı (KKKH) olan yenidoğanların nakli, profesyonel ve deneyimli personelin yanı sıra hem girişim hem de ameliyat sonrası bakım için tam donanımlı tesisler gerektirir. Bu çalışmada, KKKH olan yenidoğanlarda naklin, ameliyat süresi ve sağ kalım üzerine etkisini değerlendirmeyi ve nakil özellikleri ile klinik durum arasındaki ilişkiyi belirlemeyi amaçladık.
Gereç ve Yöntem: Üniversite hastanesine 1 Ocak 2019 ile 31 Aralık 2019 tarihleri arasında nakledilen tüm KKKH olan bebekler üzerinde retrospektif kesitsel bir kohort çalışması gerçekleştirildi. Nakil mesafesi, eşlik eden sağlık çalışanı, vital bulgular, oksijen satürasyon seviyeleri, prostaglandin E1 (PGE) kullanımı ve solunum desteği gibi nakil özellikleri kaydedildi. Nakil özelliklerinin ameliyat süresi, komplikasyonlar ve mortalite üzerindeki etkileri analiz edildi. Konjenital kalp hastalığı için mortalite ile ilişkili riskleri analiz etmek için Göğüs Cerrahları Derneği-Avrupa Kardiyo-Torasik Cerrahi Derneği (STAT) Skoru kullanıldı. Bu hastalar hastanemizde doğan KKKH'lı yenidoğanlarla karşılaştırıldı.
Bulgular: Toplam 55 kritik konjenital kalp hastalığı tanılı hasta değerlendirildi. Otuz bir yenidoğan (%56,4) hastanemizde doğdu (Hastane grubu) ve 24 yenidoğan (%43,6) başka bir merkezden transfer edildi (Hastane dışı grup). Gruplar arasında cinsiyet, gebelik yaşı, doğum ağırlığı, ameliyat öncesi süre ve hastanede kalış süresi açısından fark yoktu. Hastane dışından gelen grupta daha az ciddi STAT skor kategori hastası olmasına rağmen, 30 günlük sağkalım veya ölüm oranlarında fark yoktu. Hastane dışı grubunda, duktus bağımlı KKKH olan beş hasta (%20,8) PGE tedavisi uygulanmadan nakledilmiş ve duktus bağımlı altı hastaya (%25) nakil sırasında uygunsuz şekilde oksijen verilmişti.
Sonuç: Nakledilen bazı bebekler uygun olmayan PGE ve oksijen tedavileri almıştır. Bu nedenle, sevk veya nakil ekibi üyeleri KKKH hakkında bilgi sahibi olmalıdır. Nakil işleminin cerrahi zamanlama üzerindeki etkisi anlamlı bulunmamıştır. Bununla birlikte, hastane dışında doğan grubun daha düşük STAT skorları göstermesine rağmen, her iki grupta da benzer ölüm oranları gözlenmiştir. Bu durum, intrauterin naklin deneyimli kardiyovasküler merkezlere yönlendirilmesinin önemine işaret edebilir.

Etik Beyan

The study was approved by the Ethics Committee of the Medical Faculty at Çukurova University (Approval number 2022-125). Informed consent was obtained from legal guardians.

Kaynakça

  • Wu W, He J, Shao X. Incidence and mortality trend of congenital heart disease at the global, regional, and national level, 1990-2017. Medicine. 2020;99.
  • Hoffman JIE, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002;39:1890-900.
  • Brown KL, Ridout DA, Hoskote A, Verhulst L, Ricci M, Bull C. Delayed diagnosis of congenital heart disease worsens preoperative condition and outcome of surgery in neonates. Heart. 2006;92:1298-302.
  • Tzifa A, Barker C, Tibby SM, Simpson JM. Prenatal diagnosis of pulmonary atresia: impact on clinical presentation and early outcome. Arch Dis Child Fetal Neonatal Ed. 2007;92.
  • Divanović A, Hor K, Cnota J, Hirsch R, Kinsel-Ziter M, Michelfelder E. Prediction and perinatal management of severely restrictive atrial septum in fetuses with critical left heart obstruction: clinical experience using pulmonary venous Doppler analysis. J Thorac Cardiovasc Surg. 2011;141:988-94.
  • Tworetzky W, McElhinney DB, Reddy VM, Brook MM, Hanley FL, Silverman NH. Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome. Circulation. 2001;103:1269-73.
  • Kipps AK, Feuille C, Azakie A et al. Prenatal diagnosis of hypoplastic left heart syndrome in current era. Am J Cardiol. 2011;108:421-27.
  • Khalil M, Jux C, Rueblinger L, Behrje J, Esmaeili A, Schranz D. Acute therapy of newborns with critical congenital heart disease. Transl Pediatr. 2019;8:114-26.
  • Alkhushi N. The management of newborns with critical congenital heart diseases prior to transport to a cardiac center. Cardiothorac Surg. 2023 31:1. 2023;31:1-7.
  • Acunaş B, Uslu S, Yağmur Baş A. Turkish Neonatal Society guideline for the follow-up of high-risk newborn infants. Turk Pediatri Ars. 2018;53:180-95.
  • O’Brien SM, Jacobs JP, Pasquali SK et al. The Society of Thoracic Surgeons Congenital Heart Surgery Database mortality risk model: part 1-statistical methodology. Ann Thorac Surg. 2015;100:1054-62.
  • Gaies MG, Gurney JG, Yen AH et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med. 2010;11:234-38.
  • Karmegaraj B, Kappanayil M, Sudhakar A, Kumar RK. Impact of transport on arrival status and outcomes in newborns with heart disease: a low–middle-income country perspective. Cardiol Young. 2020;30:1001-8.
  • Levey A, Glickstein JS, Kleinman CS, et al. The impact of prenatal diagnosis of complex congenital heart disease on neonatal outcomes. Pediatr Cardiol. 2010;31:587-97.
  • Eckersley L, Sadler L, Parry E, Finucane K, Gentles TL. Timing of diagnosis affects mortality in critical congenital heart disease. Arch Dis Child. 2016;101:516-20.
  • Krishna Kumar R, Newburger JW, Gauvreau K, Kamenir SA, Hornberger LK. Comparison of outcome when hypoplastic left heart syndrome and transposition of the great arteries are diagnosed prenatally versus when diagnosis of these two conditions is made only postnatally. Am J Cardiol. 1999;83:1649-53.
  • Verheijen PM, Lisowski LA, Stoutenbeek P, et al. Prenatal diagnosis of congenital heart disease affects preoperative acidosis in the newborn patient. J Thorac Cardiovasc Surg. 2001;121:798-803.
  • Sethi N, Miller S, Hill KD. Prenatal diagnosis, management, and treatment of fetal cardiac disease. Neoreviews. 2023;24:285-99.
  • Pruetz JD, Carroll C, Trento LU et al. Outcomes of critical congenital heart disease requiring emergent neonatal cardiac intervention. Prenat Diagn. 2014;34:1127-32.
  • Sivarajan V, Penny DJ, Filan P, Brizard C, Shekerdemian LS. Impact of antenatal diagnosis of hypoplastic left heart syndrome on the clinical presentation and surgical outcomes: the Australian experience. J Paediatr Child Health. 2009;45:112-17.
  • Simpson LL, Harvey-Wilkes K, D’Alton ME. Congenital heart disease: the impact of delivery in a tertiary care center on SNAP scores (scores for neonatal acute physiology). Am J Obstet Gynecol. 2000;182:184-91.
  • Sasikumar D, Prabhu MA, Kurup R, et al. Outcomes of neonatal critical congenital heart disease: results of a prospective registry-based study from South India. Arch Dis Child. 2023;108:889-94.
  • Aggarwal K, Gupta R, Sharma S, Sehgal R, Roy M. Mortality in newborns referred to tertiary hospital: An introspection. J Family Med Prim Care. 2015;4:435.
  • Goldsmit G, Rabasa C, Rodríguez S et al. Risk factors associated to clinical deterioration during the transport of sick newborn infants. Arch Argent Pediatr. 2012;110:304-9.
  • Yeager SB, Horbar JD, Greco KM, Duff J, Thiagarajan RR, Laussen PC. Pretransport and posttransport characteristics and outcomes of neonates who were admitted to a cardiac intensive care unit. Pediatrics. 2006;118:1070-7.
  • Taksande A, Jameel PZ. Critical Congenital heart disease in neonates: a review article. Curr Pediatr Rev. 2021;17:120-6.

Impact of transport outcomes of outborn newborns with critical congenital heart disease on surgery time and mortality rates

Yıl 2024, Cilt: 49 Sayı: 1, 62 - 70, 29.03.2024
https://doi.org/10.17826/cumj.1379435

Öz

Purpose: Transport of neonates with critical congenital heart disease (CCHD) necessitates professional and experienced staff and, well-equipped facilities for both the procedure and post-operative care. In this study, we aimed to evaluate the effect of transport on operation time and survival in neonates with CCHD and determine the relationship between transport characteristics and clinical status.
Materials and Methods: A retrospective cross-sectional cohort study was conducted on all infants with CCHD who were transported to a university hospital between January 1, 2019 and December 31, 2019. Transport characteristics such as transport distance, accompanying healthcare provider, vital signs, oxygen saturation levels, prostaglandin E1 (PGE) use, and respiratory support were recorded. The effects of transport characteristics on surgery time, complications, and mortality were analyzed. The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) Score was used to analyze mortality-related risks for congenital heart disease. They were compared with inborn newborns with CCHD.
Results: A total of 55 patients with CCHD were evaluated. Thirty-one newborns (56.4%) were inborn (Inborn group), and 24 newborns (43.6%) were transferred from another center (Outborn group). There was no difference between the groups in terms of gender, gestational age, birth weight, pre-operative time, and hospital stay. Although the Outborn group had fewer STAT Score categories, there was no difference in the 30-day survival or mortality rates. In the Outborn group, five patients (20.8%) with duct-dependent CCHD were transported without PGE treatment and six duct-dependent (25%) patients received oxygen during transport inappropriately.
Conclusion: The administration of PGE and oxygen therapies to specific transported infants was inappropriate. Therefore, referral or transport team members should be familiar infants with CCHD. The impact of transport on surgical timing did not yield a significant effect. However, similar mortality rates were observed in both groups, despite the Outborn group demonstrating lower STAT scores. This may indicate the significance of referring intrauterine transportation to experienced cardiovascular centers.

Kaynakça

  • Wu W, He J, Shao X. Incidence and mortality trend of congenital heart disease at the global, regional, and national level, 1990-2017. Medicine. 2020;99.
  • Hoffman JIE, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002;39:1890-900.
  • Brown KL, Ridout DA, Hoskote A, Verhulst L, Ricci M, Bull C. Delayed diagnosis of congenital heart disease worsens preoperative condition and outcome of surgery in neonates. Heart. 2006;92:1298-302.
  • Tzifa A, Barker C, Tibby SM, Simpson JM. Prenatal diagnosis of pulmonary atresia: impact on clinical presentation and early outcome. Arch Dis Child Fetal Neonatal Ed. 2007;92.
  • Divanović A, Hor K, Cnota J, Hirsch R, Kinsel-Ziter M, Michelfelder E. Prediction and perinatal management of severely restrictive atrial septum in fetuses with critical left heart obstruction: clinical experience using pulmonary venous Doppler analysis. J Thorac Cardiovasc Surg. 2011;141:988-94.
  • Tworetzky W, McElhinney DB, Reddy VM, Brook MM, Hanley FL, Silverman NH. Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome. Circulation. 2001;103:1269-73.
  • Kipps AK, Feuille C, Azakie A et al. Prenatal diagnosis of hypoplastic left heart syndrome in current era. Am J Cardiol. 2011;108:421-27.
  • Khalil M, Jux C, Rueblinger L, Behrje J, Esmaeili A, Schranz D. Acute therapy of newborns with critical congenital heart disease. Transl Pediatr. 2019;8:114-26.
  • Alkhushi N. The management of newborns with critical congenital heart diseases prior to transport to a cardiac center. Cardiothorac Surg. 2023 31:1. 2023;31:1-7.
  • Acunaş B, Uslu S, Yağmur Baş A. Turkish Neonatal Society guideline for the follow-up of high-risk newborn infants. Turk Pediatri Ars. 2018;53:180-95.
  • O’Brien SM, Jacobs JP, Pasquali SK et al. The Society of Thoracic Surgeons Congenital Heart Surgery Database mortality risk model: part 1-statistical methodology. Ann Thorac Surg. 2015;100:1054-62.
  • Gaies MG, Gurney JG, Yen AH et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med. 2010;11:234-38.
  • Karmegaraj B, Kappanayil M, Sudhakar A, Kumar RK. Impact of transport on arrival status and outcomes in newborns with heart disease: a low–middle-income country perspective. Cardiol Young. 2020;30:1001-8.
  • Levey A, Glickstein JS, Kleinman CS, et al. The impact of prenatal diagnosis of complex congenital heart disease on neonatal outcomes. Pediatr Cardiol. 2010;31:587-97.
  • Eckersley L, Sadler L, Parry E, Finucane K, Gentles TL. Timing of diagnosis affects mortality in critical congenital heart disease. Arch Dis Child. 2016;101:516-20.
  • Krishna Kumar R, Newburger JW, Gauvreau K, Kamenir SA, Hornberger LK. Comparison of outcome when hypoplastic left heart syndrome and transposition of the great arteries are diagnosed prenatally versus when diagnosis of these two conditions is made only postnatally. Am J Cardiol. 1999;83:1649-53.
  • Verheijen PM, Lisowski LA, Stoutenbeek P, et al. Prenatal diagnosis of congenital heart disease affects preoperative acidosis in the newborn patient. J Thorac Cardiovasc Surg. 2001;121:798-803.
  • Sethi N, Miller S, Hill KD. Prenatal diagnosis, management, and treatment of fetal cardiac disease. Neoreviews. 2023;24:285-99.
  • Pruetz JD, Carroll C, Trento LU et al. Outcomes of critical congenital heart disease requiring emergent neonatal cardiac intervention. Prenat Diagn. 2014;34:1127-32.
  • Sivarajan V, Penny DJ, Filan P, Brizard C, Shekerdemian LS. Impact of antenatal diagnosis of hypoplastic left heart syndrome on the clinical presentation and surgical outcomes: the Australian experience. J Paediatr Child Health. 2009;45:112-17.
  • Simpson LL, Harvey-Wilkes K, D’Alton ME. Congenital heart disease: the impact of delivery in a tertiary care center on SNAP scores (scores for neonatal acute physiology). Am J Obstet Gynecol. 2000;182:184-91.
  • Sasikumar D, Prabhu MA, Kurup R, et al. Outcomes of neonatal critical congenital heart disease: results of a prospective registry-based study from South India. Arch Dis Child. 2023;108:889-94.
  • Aggarwal K, Gupta R, Sharma S, Sehgal R, Roy M. Mortality in newborns referred to tertiary hospital: An introspection. J Family Med Prim Care. 2015;4:435.
  • Goldsmit G, Rabasa C, Rodríguez S et al. Risk factors associated to clinical deterioration during the transport of sick newborn infants. Arch Argent Pediatr. 2012;110:304-9.
  • Yeager SB, Horbar JD, Greco KM, Duff J, Thiagarajan RR, Laussen PC. Pretransport and posttransport characteristics and outcomes of neonates who were admitted to a cardiac intensive care unit. Pediatrics. 2006;118:1070-7.
  • Taksande A, Jameel PZ. Critical Congenital heart disease in neonates: a review article. Curr Pediatr Rev. 2021;17:120-6.
Toplam 26 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Çocuk Kardiyolojisi, Yenidoğan
Bölüm Araştırma
Yazarlar

Tugay Tepe 0000-0002-7926-8442

Ahmet İbrahim Kurtoğlu 0000-0001-8581-5652

Hacer Yapıcıoğlu 0000-0001-6295-553X

Mustafa Özdemir 0000-0001-5644-8283

Nejat Narlı 0000-0002-0474-3288

Ferda Özlü 0000-0002-2092-8426

Sevcan Erdem 0000-0001-5914-9166

İlker Ünal 0000-0002-9485-3295

Yayımlanma Tarihi 29 Mart 2024
Gönderilme Tarihi 21 Ekim 2023
Kabul Tarihi 5 Şubat 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 49 Sayı: 1

Kaynak Göster

MLA Tepe, Tugay vd. “Impact of Transport Outcomes of Outborn Newborns With Critical Congenital Heart Disease on Surgery Time and Mortality Rates”. Cukurova Medical Journal, c. 49, sy. 1, 2024, ss. 62-70, doi:10.17826/cumj.1379435.