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J Pediatr ; 204: 66-70, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30292491

RESUMO

OBJECTIVE: To establish the impact that timing of diagnosis and place of birth have on neonatal outcomes in those with readily treatable critical congenital heart disease. STUDY DESIGN: This was a population-based study with a complete national cohort of live-born infants with transposition of the great arteries and aortic arch obstruction in New Zealand between 2006 and 2014. Timing of diagnosis, place of birth, survival to surgery, in-hospital events, and neonatal mortality were reviewed. Live births with a gestation of ≥35 weeks and without associated major extracardiac anomalies were included for analysis. RESULTS: A total of 166 live-born infants with transposition of the great arteries and 87 with aortic arch obstruction were included. Antenatal detection increased from 32% in the first 3 years to 47% in the last 3 years (P = .05). During the same period, neonatal mortality decreased from 9% to 1% (P = .02). No deaths occurred after surgical intervention. An antenatal diagnosis was associated with decreased mortality (1/97 [1%] vs 11/156 [7%]; P = .03) and birth outside the surgical center was associated with increased risk of mortality (11/147 [7%] vs 1/106 [1%]; P = .02). Those with an antenatal diagnosis required fewer hours of mechanical ventilation (P = .02) and had shorter durations of hospital stay (P = .05) compared with those diagnosed >48 hours after birth. CONCLUSIONS: The mortality risk for transposition of the great arteries and critical aortic arch obstruction is greatest before cardiac surgery. Improved antenatal detection allowing delivery at a surgical center is associated with reduced mortality.


Assuntos
Síndromes do Arco Aórtico/mortalidade , Mortalidade Infantil/tendências , Diagnóstico Pré-Natal/estatística & dados numéricos , Transposição dos Grandes Vasos/mortalidade , Síndromes do Arco Aórtico/complicações , Síndromes do Arco Aórtico/diagnóstico , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Nova Zelândia , Gravidez , Fatores de Tempo , Transposição dos Grandes Vasos/complicações , Transposição dos Grandes Vasos/diagnóstico
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