Comparison of two approaches for newborn with critical congenital heart disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Guanxi , PANG Kunjing , MA Kai , RUI lu , WANG Xu , YAN Jun , HUA Zhongdong , WANG Qiang , YAN Fuxia , LIU Jinping , ZHANG Huili , LIN Ye , ZHANG Benqing , MENG Hong , YANG Juxian ,  LI Shoujun

Pediatric Cardiac Surgery Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, P.R.China;

Corresponding?author：

LI Shoujun, Email: drlishoujunfw@163.com

Keywords：

Newborn; critical congenital heart diseases; green channel

DOI：

10.7507/1007-4848.202010004

Video：

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Objective To summarize our experience of critical congenital heart diseases treatment system for the newborn and to report its surgical results.Methods We reviewed the clinical data of 97 neonates with congenital heart diseases who admitted to pediatric cardiac center from January 2019 to August 2020 in our hospital. The patients were divided into a prenatal and postnatal diagnosis and treatment integration group (integrated group, n=41), and a postnatal diagnosis and rapid admission by green channel group (non-integrated group, n=56).Results The age of admission in the integrated group was younger than that in the non-integrated group (3.0 d vs. 11.0 d, P<0.001), and the weight was lighter (3.3±0.4 kg vs. 3.6±0.6 kg, P=0.006), operation age was younger (13.0 d vs. 17.5 d, P=0.004), proportion of palliative surgery was smaller (2.4% vs. 8.9%, P=0.396), time for ventilator assistance was longer (153.0 h vs. 65.0 h, P=0.020), hospital mortality was lower (0.0% vs. 7.1%, P=0.135). There was no significant difference in the follow-up (11.0 months vs. 12 months, P=1.000), out-of-hospital mortality (2.4% vs. 1.8%, P=1.000) and total mortality (2.4% vs. 8.9%, P=0.396) between the two groups.Conclusion Prenatal and postnatal diagnosis and treatment integration can significantly shorten the diagnosis and the hospitalization interval of newborn, that surgical intervention could be performed timely. It can reduce the risk of death before surgery but need longer time for recovery after surgery. Patients with postnatal diagnosis and admitted hospital through green channel also can get perfect results if surgical intervention is performed timely.

1.	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. Lancet, 2014, 384(9945): 747-754.
2.	Ma XJ, Huang GY. Current status of screening, diagnosis, and treatment of neonatal congenital heart disease in China. World J Pediatr, 2018, 14(4): 313-314.
3.	張惠麗李守軍, 閆軍, 等. 新生兒復雜先天性心臟病15年治療分析. 中華新生兒科雜志, 2019, 34(6): 401-407.
4.	Chu C, Yan Y, Ren Y, et al. Prenatal diagnosis of congenital heart diseases by fetal echocardiography in second trimester: A Chinese multicenter study. Acta Obstet Gynecol Scand, 2017, 96(4): 454-463.
5.	中華醫學會胸心血管外科學分會, 中華醫學會小兒外科學分會心胸外科學組, 國家心血管病中心先天性心臟病專業委員會, 等. 中國心臟出生缺陷圍產期診斷和臨床評估處置專家共識. 中華小兒外科雜志, 2018, 39(3): 163-170, 195.
6.	趙趣鳴, 劉芳, 吳琳, 等. 危重先天性心臟病新生兒產科醫院出院前漏診情況分析. 中華兒科雜志, 2017, 55(4): 260-266.
7.	蘇肇伉, 徐志偉, 王順民, 等. 新生兒和小嬰兒復雜先天性心臟病手術的發展和優化. 中國循環雜志, 2005, 20(6): 406-410.
8.	吳勇, 劉小清, 曲艷吉, 等. 新生兒先天性心臟病2001至2014年單中心外科治療狀況. 嶺南心血管病雜志, 2016, 22(6): 678-683.
9.	周誠, 董念國, 杜心靈, 等. 危重新生兒先心病外科治療. 中華小兒外科雜志, 2012, 33(8): 593-596.
10.	陳浩, 徐志偉, 王浩, 等. 低體質量新生兒先天性心臟病外科手術的危險因素. 中華胸心血管外科雜志, 2017, 33(5): 271-275.
11.	洪亮, 張慧麗, 王旭, 等. 先天性心臟病救治網絡系統平臺——新型的綜合轉診系統的應用. 中國循環雜志, 2013, 28(5): 371-374.
12.	劉小清, 莊建, 陳寄梅, 等. 先天性心臟病產前產后一體化診療模式效果初步評估. 中華胸心血管外科雜志, 2014, 30(12): 723-726.
13.	Liu X, Hong HF, Zhang HB, et al. Neonatal surgical outcomes after prenatal diagnosis of complex congenital heart disease: Experiences of a perinatal integrated diagnosis and treatment program. World J Pediatr, 2020, 16(5): 494-501.
14.	Quartermain MD, Hill KD, Goldberg DJ, et al. Prenatal diagnosis influences preoperative status in neonates with congenital heart disease: An analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Pediatr Cardiol, 2019, 40(3): 489-496.
15.	金梅, 韓玲, 張桂珍, 等. 先天性心臟病篩查治療和監測網絡平臺建立與規范化管理的研究. 心肺血管病雜志, 2010, 29(2): 81-84.
16.	王音, 王崢, 徐鵬, 等. 西北地區單中心胎兒先心病超聲診斷與一體化管理的初步研究. 中華超聲影像學雜志, 2018, 27(9): 759-765.
17.	韓鳳珍, 江燕萍, 周成斌, 等. 胎兒先天性心臟病151例圍生結局及預后分析. 實用婦產科雜志, 2012, 28(9): 760-764.
18.	韓霞, 楊文紅, 喻茜, 等. 經皮血氧飽和度檢測結合臨床評估篩查新生兒先天性心臟病的可行性研究. 中國兒童保健雜志, 2018, 26(3): 251-253.
19.	中華醫學會小兒外科學分會心胸外科學組. 新生兒危重先天性心臟病術前評估中國專家共識(草案). 中華小兒外科雜志, 2017, 38(3): 164-169.
20.	Costello JM, Pasquali SK, Jacobs JP, et al. Gestational age at birth and outcomes after neonatal cardiac surgery: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Circulation, 2014, 129(24): 2511-2517.
21.	Kansy A, Tobota Z, Maruszewski P, et al. Analysis of 14, 843 neonatal congenital heart surgical procedures in the European Association for Cardiothoracic Surgery Congenital Database. Ann Thorac Surg, 2010, 89(4): 1255-1259.
22.	Peyvandi S, De Santiago V, Chakkarapani E, et al. Association of prenatal diagnosis of critical congenital heart disease with postnatal brain development and the risk of brain injury. JAMA Pediatr, 2016, 170(4): e154450.
23.	Lim JM, Porayette P, Marini D, et al. Associations between age at arterial switch operation, brain growth, and development in infants with transposition of the great arteries. Circulation, 2019, 139(24): 2728-2738.
24.	Costello JM, Polito A, Brown DW, et al. Birth before 39 weeks' gestation is associated with worse outcomes in neonates with heart disease. Pediatrics, 2010, 126(2): 277-284.

1. 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. Lancet, 2014, 384(9945): 747-754.
2. Ma XJ, Huang GY. Current status of screening, diagnosis, and treatment of neonatal congenital heart disease in China. World J Pediatr, 2018, 14(4): 313-314.
3. 張惠麗李守軍, 閆軍, 等. 新生兒復雜先天性心臟病15年治療分析. 中華新生兒科雜志, 2019, 34(6): 401-407.
4. Chu C, Yan Y, Ren Y, et al. Prenatal diagnosis of congenital heart diseases by fetal echocardiography in second trimester: A Chinese multicenter study. Acta Obstet Gynecol Scand, 2017, 96(4): 454-463.
5. 中華醫學會胸心血管外科學分會, 中華醫學會小兒外科學分會心胸外科學組, 國家心血管病中心先天性心臟病專業委員會, 等. 中國心臟出生缺陷圍產期診斷和臨床評估處置專家共識. 中華小兒外科雜志, 2018, 39(3): 163-170, 195.
6. 趙趣鳴, 劉芳, 吳琳, 等. 危重先天性心臟病新生兒產科醫院出院前漏診情況分析. 中華兒科雜志, 2017, 55(4): 260-266.
7. 蘇肇伉, 徐志偉, 王順民, 等. 新生兒和小嬰兒復雜先天性心臟病手術的發展和優化. 中國循環雜志, 2005, 20(6): 406-410.
8. 吳勇, 劉小清, 曲艷吉, 等. 新生兒先天性心臟病2001至2014年單中心外科治療狀況. 嶺南心血管病雜志, 2016, 22(6): 678-683.
9. 周誠, 董念國, 杜心靈, 等. 危重新生兒先心病外科治療. 中華小兒外科雜志, 2012, 33(8): 593-596.
10. 陳浩, 徐志偉, 王浩, 等. 低體質量新生兒先天性心臟病外科手術的危險因素. 中華胸心血管外科雜志, 2017, 33(5): 271-275.
11. 洪亮, 張慧麗, 王旭, 等. 先天性心臟病救治網絡系統平臺——新型的綜合轉診系統的應用. 中國循環雜志, 2013, 28(5): 371-374.
12. 劉小清, 莊建, 陳寄梅, 等. 先天性心臟病產前產后一體化診療模式效果初步評估. 中華胸心血管外科雜志, 2014, 30(12): 723-726.
13. Liu X, Hong HF, Zhang HB, et al. Neonatal surgical outcomes after prenatal diagnosis of complex congenital heart disease: Experiences of a perinatal integrated diagnosis and treatment program. World J Pediatr, 2020, 16(5): 494-501.
14. Quartermain MD, Hill KD, Goldberg DJ, et al. Prenatal diagnosis influences preoperative status in neonates with congenital heart disease: An analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Pediatr Cardiol, 2019, 40(3): 489-496.
15. 金梅, 韓玲, 張桂珍, 等. 先天性心臟病篩查治療和監測網絡平臺建立與規范化管理的研究. 心肺血管病雜志, 2010, 29(2): 81-84.
16. 王音, 王崢, 徐鵬, 等. 西北地區單中心胎兒先心病超聲診斷與一體化管理的初步研究. 中華超聲影像學雜志, 2018, 27(9): 759-765.
17. 韓鳳珍, 江燕萍, 周成斌, 等. 胎兒先天性心臟病151例圍生結局及預后分析. 實用婦產科雜志, 2012, 28(9): 760-764.
18. 韓霞, 楊文紅, 喻茜, 等. 經皮血氧飽和度檢測結合臨床評估篩查新生兒先天性心臟病的可行性研究. 中國兒童保健雜志, 2018, 26(3): 251-253.
19. 中華醫學會小兒外科學分會心胸外科學組. 新生兒危重先天性心臟病術前評估中國專家共識(草案). 中華小兒外科雜志, 2017, 38(3): 164-169.
20. Costello JM, Pasquali SK, Jacobs JP, et al. Gestational age at birth and outcomes after neonatal cardiac surgery: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Circulation, 2014, 129(24): 2511-2517.
21. Kansy A, Tobota Z, Maruszewski P, et al. Analysis of 14, 843 neonatal congenital heart surgical procedures in the European Association for Cardiothoracic Surgery Congenital Database. Ann Thorac Surg, 2010, 89(4): 1255-1259.
22. Peyvandi S, De Santiago V, Chakkarapani E, et al. Association of prenatal diagnosis of critical congenital heart disease with postnatal brain development and the risk of brain injury. JAMA Pediatr, 2016, 170(4): e154450.
23. Lim JM, Porayette P, Marini D, et al. Associations between age at arterial switch operation, brain growth, and development in infants with transposition of the great arteries. Circulation, 2019, 139(24): 2728-2738.
24. Costello JM, Polito A, Brown DW, et al. Birth before 39 weeks' gestation is associated with worse outcomes in neonates with heart disease. Pediatrics, 2010, 126(2): 277-284.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesComparison of two approaches for newborn with critical congenital heart disease

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