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Ginsberg GM, Drukker L, Pollak U, Brezis M. Cost-utility analysis of prenatal diagnosis of congenital cardiac diseases using deep learning. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:44. [PMID: 38773527 PMCID: PMC11110271 DOI: 10.1186/s12962-024-00550-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/24/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Deep learning (DL) is a new technology that can assist prenatal ultrasound (US) in the detection of congenital heart disease (CHD) at the prenatal stage. Hence, an economic-epidemiologic evaluation (aka Cost-Utility Analysis) is required to assist policymakers in deciding whether to adopt the new technology. METHODS The incremental cost-utility ratios (CUR), of adding DL assisted ultrasound (DL-US) to the current provision of US plus pulse oximetry (POX), was calculated by building a spreadsheet model that integrated demographic, economic epidemiological, health service utilization, screening performance, survival and lifetime quality of life data based on the standard formula: CUR = Increase in Intervention Costs - Decrease in Treatment costs Averted QALY losses of adding DL to US & POX US screening data were based on real-world operational routine reports (as opposed to research studies). The DL screening cost of 145 USD was based on Israeli US costs plus 20.54 USD for reading and recording screens. RESULTS The addition of DL assisted US, which is associated with increased sensitivity (95% vs 58.1%), resulted in far fewer undiagnosed infants (16 vs 102 [or 2.9% vs 15.4%] of the 560 and 659 births, respectively). Adoption of DL-US will add 1,204 QALYs. with increased screening costs 22.5 million USD largely offset by decreased treatment costs (20.4 million USD). Therefore, the new DL-US technology is considered "very cost-effective", costing only 1,720 USD per QALY. For most performance combinations (sensitivity > 80%, specificity > 90%), the adoption of DL-US is either cost effective or very cost effective. For specificities greater than 98% (with sensitivities above 94%), DL-US (& POX) is said to "dominate" US (& POX) by providing more QALYs at a lower cost. CONCLUSION Our exploratory CUA calculations indicate the feasibility of DL-US as being at least cost-effective.
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Affiliation(s)
- Gary M Ginsberg
- Braun School of Public Health, Hebrew University, Jerusalem, Israel.
- HECON, Health Economics Consultancy, Jerusalem, Israel.
| | - Lior Drukker
- Department of Obstetrics and Gynecology, Rabin-Belinson Medical Center, Petah Tikva, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Uri Pollak
- Pediatric Critical Care Sector, Hadassah University Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University Medical Center, Jerusalem, Israel
| | - Mayer Brezis
- Braun School of Public Health, Hebrew University, Jerusalem, Israel
- Center for Quality and Safety, Hadassah University Medical Center, Jerusalem, Israel
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Dilli D, Akduman H, Zenciroğlu A, Çetinkaya M, Okur N, Turan Ö, Özlü F, Çalkavur Ş, Demirel G, Koksal N, Çolak R, Örün UA, Öztürk E, Gül Ö, Tokel NK, Erdem S, Meşe T, Erdem A, Bostan ÖM, Polat TB, Taşar M, Hatemi AC, Doyurgan O, Özkan M, Avşar MK, Sarıosmanoğlu ON, Uğurlucan M, Sığnak IŞ, Başaran M. Neonatal Outcomes of Critical Congenital Heart Defects: A Multicenter Epidemiological Study of Turkish Neonatal Society : Neonatal Outcomes of CCHD. Pediatr Cardiol 2024; 45:257-271. [PMID: 38153547 DOI: 10.1007/s00246-023-03362-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/20/2023] [Indexed: 12/29/2023]
Abstract
Critical congenital heart disease (CCHD) is one of the leading causes of neonatal and infant mortality. We aimed to elucidate the epidemiology, spectrum, and outcome of neonatal CCHD in Türkiye. This was a multicenter epidemiological study of neonates with CCHD conducted from October 2021 to November 2022 at national tertiary health centers. Data from 488 neonatal CCHD patients from nine centers were entered into the Trials-Network online registry system during the study period. Transposition of great arteria was the most common neonatal CHD, accounting for 19.5% of all cases. Sixty-three (12.9%) patients had extra-cardiac congenital anomalies. A total of 325 patients underwent cardiac surgery. Aortic arch repair (29.5%), arterial switch (25.5%), and modified Blalock-Taussig shunt (13.2%). Overall, in-hospital mortality was 20.1% with postoperative mortality of 19.6%. Multivariate analysis showed that the need of prostaglandin E1 before intervention, higher VIS (> 17.5), the presence of major postoperative complications, and the need for early postoperative extracorporeal membrane oxygenation were the main risk factors for mortality. The mortality rate of CCHD in our country remains high, although it varies by health center. Further research needs to be conducted to determine long-term outcomes for this vulnerable population.
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Affiliation(s)
- Dilek Dilli
- Department of Neonatology, Dr. Sami Ulus Research and Application Center, Health Science University of Turkey, Ankara, Turkey.
| | - Hasan Akduman
- Department of Neonatology, Dr. Sami Ulus Research and Application Center, Health Science University of Turkey, Ankara, Turkey
| | - Ayşegül Zenciroğlu
- Department of Neonatology, Dr. Sami Ulus Research and Application Center, Health Science University of Turkey, Ankara, Turkey
| | - Merih Çetinkaya
- Department of Neonatology, Başakşehir Çam Sakura City Hospital, Health Science University of Turkey, İstanbul, Turkey
| | - Nilüfer Okur
- Department of Neonatology, Gazi Yaşargil Research and Application Center, Health Science University of Turkey, Diyarbakır, Turkey
| | - Özden Turan
- Department of Neonatology, Başkent University, Medical Faculty, Ankara, Turkey
| | - Ferda Özlü
- Department of Neonatology, Çukurova University, Medical Faculty, Adana, Turkey
| | - Şebnem Çalkavur
- Department of Neonatology, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Health Science University of Turkey, İzmir, Turkey
| | - Gamze Demirel
- Department of Neonatology, İstanbul Medipol University, International Faculty of Medicine, Istanbul, Turkey
| | - Nilgün Koksal
- Department of Neonatology, Uludağ University, Medical Faculty, Bursa, Turkey
| | - Rüya Çolak
- Department of Neonatology, Beykent University Medical Faculty, Istanbul, Turkey
| | - Utku Arman Örün
- Department of Pediatric Cardiology, Dr. Sami Ulus Research and Application Center, Health Science University of Turkey, Ankara, Turkey
| | - Erkut Öztürk
- Department of Pediatric Cardiology, Başakşehir Çam Sakura City Hospital, Health Science University of Turkey, Istanbul, Turkey
| | - Özlem Gül
- Department of Pediatric Cardiology, Gazi Yaşargil Research and Application Center, Health Science University of Turkey, Diyarbakır, Turkey
| | - Niyazi Kürşad Tokel
- Department of Pediatric Cardiology, Başkent University, Medical Faculty, Ankara, Turkey
| | - Sevcan Erdem
- Department of Pediatric Cardiology, Çukurova University, Medical Faculty, Adana, Turkey
| | - Timur Meşe
- Department of Pediatric Cardiology, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Health Science University of Turkey, İzmir, Turkey
| | - Abdullah Erdem
- Department of Pediatric Cardiology, İstanbul Medipol University, International Faculty of Medicine, İstanbul, Turkey
| | - Özlem Mehtap Bostan
- Department of Pediatric Cardiology, Uludağ University, Medical Faculty, Bursa, Turkey
| | - Tuğçin Bora Polat
- Department of Pediatric Cardiology, Beykent University, Medical Faculty, İstanbul, Turkey
| | - Mehmet Taşar
- Department of Pediatric Cardiovascular Surgery, Dr. Sami Ulus Research and Application Center, Health Science University of Turkey, Ankara, Turkey
| | - Ali Can Hatemi
- Department of Pediatric Cardiovascular Surgery, Başakşehir Çam Sakura City Hospital, Health Science University of Turkey, İstanbul, Turkey
| | - Onur Doyurgan
- Department of Pediatric Cardiovascular Surgery, Gazi Yaşargil Research and Application Center, Health Science University of Turkey, Diyarbakır, Turkey
| | - Murat Özkan
- Department of Pediatric Cardiovascular Surgery, Başkent University, Medical Faculty, Ankara, Turkey
| | - Mustafa Kemal Avşar
- Department of Pediatric Cardiovascular Surgery, Çukurova University, Medical Faculty, Adana, Turkey
| | - Osman Nejat Sarıosmanoğlu
- Department of Pediatric Cardiovascular Surgery, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Health Science University of Turkey, İzmir, Turkey
| | - Murat Uğurlucan
- Department of Pediatric Cardiovascular Surgery, İstanbul Medipol University, International Faculty of Medicine, İstanbul, Turkey
| | - Işık Şenkaya Sığnak
- Department of Pediatric Cardiovascular Surgery, Uludağ University, Medical Faculty, Bursa, Turkey
| | - Murat Başaran
- Department of Pediatric Cardiovascular Surgery, Beykent University, Medical Faculty, Istanbul, Turkey
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Jarrell DK, Jacot JG. An In Vitro Characterization of a PCL-Fibrin Scaffold for Myocardial Repair. MATERIALS TODAY. COMMUNICATIONS 2023; 37:107596. [PMID: 38130877 PMCID: PMC10732481 DOI: 10.1016/j.mtcomm.2023.107596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Each year in the United States approximately 10,000 babies are born with a complex congenital heart defect (CHD) requiring surgery in the first year of after birth. Several of these operations require the implantation of a full-thickness heart patch; however, the current patch materials available to pediatric heart surgeons are exclusively non-living and non-degradable, which do not grow with the patient and are prone to fail due to an inability to integrate with the heart. In this work, the goal was to develop a full-thickness, tissue engineered myocardial patch (TEMP) that is made from biodegradable components, strong enough to withstand the mechanical forces of the heart wall, and able to integrate with the heart and drive neotissue formation. Here, a thick and porous electrospun PCL scaffold filled with high-salt PEGylated fibrin was developed. The scaffold was found to be mechanically sufficient for heart wall repair. Vascular cells were able to infiltrate more than halfway through the scaffold in static culture within three weeks. The scaffold maintained pluripotent stem cells for at least four days, supports viable iPSC-derived cardiomyocytes, and fostered tissue thickening in vitro. The TEMP developed here and tested in vitro is promising for the repair of structural CHD and will next be assessed in situ.
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Affiliation(s)
- Dillon K Jarrell
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus
| | - Jeffrey G Jacot
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus
- Department of Pediatrics, Children’s Hospital Colorado
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Uke P, Gaikwad SB, Swarnkar K, Lamture V, Khartade P. Neurodevelopmental assessment of children with congenital heart diseases using Trivandrum developmental screening chart. J Neurosci Rural Pract 2023; 14:692-697. [PMID: 38059228 PMCID: PMC10696322 DOI: 10.25259/jnrp_46_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 07/14/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives Congenital heart diseases (CHDs) are one of the most important congenital anomalies in children which have high-risk for neurodevelopment delay. This study was conducted to determine the proportion of developmental delay in children with CHD and comparison of delay between acyanotic and cyanotic heart diseases in children. Materials and Methods A cross-sectional study was conducted on children admitted in pediatric ward of rural hospital from 6 month to 6 years of age who are diagnosed with CHD by 2D ECHO and further classified into acyanotic congenital heart disease (ACHD) and cyanotic congenital heart disease (CCHD). Neurodevelopmental assessment was done using Trivandrum development screening chart (TDSC). Results Out of total 50 children in study population, 24 children had TDSC delay, distribution as 11 (22%) ACHD and 13 (26%) CCHD. Out of 24 children in the age group of 0-3 years, 13 (54.2%) were ACHD and 11 (45.8%) were CCHD. Out of 26 children in the age group of 3-6 years, 15 (57.7%) were ACHD and 11 (42.3%) were CCHD. Among different ACHD included in the study population (0-3 years) children with ventricular septal defect (VSD) were maximum (n = 5) next in the decreasing order was atrial septal defect (ASD) (n = 3). ACHD included in the study population (3-6 years) children with VSD was maximum (n = 6) next in the order was ASD (n = 4). Proportion of delay in children with ACHD was 22% as compared to 26% in children with CCHD. Conclusion There is a high proportion of neurodevelopmental delay in children with CHD which can be detected using TDSC which is a simple screening tool and can be used by any health-care professional without training for the assessment of neurodevelopmental outcome in these children. Delay was more in children with CCHD than ACHD.
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Affiliation(s)
- Punam Uke
- Department of Pediatrics, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
| | | | - Keerti Swarnkar
- Department of Pediatrics, AIIMS, Bhopal, Madhya Pradesh, India
| | - Varsha Lamture
- Department of Pediatrics, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
| | - Prashant Khartade
- Department of Pediatrics, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
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Palma A, Morais S, Silva PV, Pires A. Congenital heart defects and preterm birth: Outcomes from a referral center. Rev Port Cardiol 2023; 42:403-410. [PMID: 36828187 DOI: 10.1016/j.repc.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 05/17/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Preterm birth and congenital heart defects are two major causes of neonatal and infant mortality. However, the relationship between them has not yet been fully clarified. OBJECTIVE To determine the prevalence and spectrum of congenital heart defects in preterms, the specific associations between categories of congenital heart defects and preterm birth and to establish the influence on outcomes. METHODS Observational, case-control analysis that included 448 live births with congenital heart defects born between 2003 and 2017. Preterm with congenital heart defects were the case subjects and term neonates with congenital heart defects the control subjects. RESULTS Of the newborns with congenital heart defects, 23% were preterm. The odds of congenital heart defects in preterm were twofold higher than for term neonates (p<0.0001), even when considering only those with severe congenital heart defects (p=0.0002). The odds in preterm were 9.2-fold higher for abnormalities of the atria and atrial septum (p<0.0001) and two-fold higher for abnormalities of the ventricles and ventricular septum (p<0.0001) compared with term neonates. The neonatal mortality rate in the preterm group was not statistically different from that of the term group with congenital heart defects (p=0.799) or severe congenital heart defects (p=0.554). CONCLUSION Preterm have more than twice as many congenital heart defects as term neonates. Although the etiology of prematurity between infants with congenital heart defects is still uncertain, our findings highlight a possible relationship between prematurity and congenital heart defects.
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Affiliation(s)
- Andreia Palma
- Department of Pediatric Cardiology, Referral Center for Congenital Cardiac Defects, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Sofia Morais
- Department of Neonatology, Bissaya Barreto Maternity, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Patrícia V Silva
- Department of Pediatric Cardiology, Referral Center for Congenital Cardiac Defects, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - António Pires
- Department of Pediatric Cardiology, Referral Center for Congenital Cardiac Defects, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Simeone S, Rea T, Platone N, Guillari A, Lanzuise A, Assanta N, Da Valle P, Baratta S, Pucciarelli G. Quality of Life of Families with Children Presenting Congenital Heart Disease:Longitudinal Study Protocol. Healthcare (Basel) 2022; 10:healthcare10071273. [PMID: 35885800 PMCID: PMC9317531 DOI: 10.3390/healthcare10071273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/28/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND: Advances in medicine have caused a notable increase in the survival rates of children born with congenital heart disease, even in the most complicated cases, almost mitigating the disease’s pathology from lethal to chronic. The quality of life perceived by such children is influenced by the perceptions of their parents. However, the international literature has rarely considered the entire family nucleus. AIMS: This study aims to study the temporal trend of quality of life of families with children with congenital heart disease, particularly with respect to parents following a child’s hospitalization for an invasive procedure. DESIGN: A longitudinal study. METHOD: A sample of families (that is, those including a child with congenital heart disease and their parents) will be enrolled following the patient’s discharge from the hospital and examined every 3 months for 1 year. The study’s adopted hypothesis is that there is an interdependence between the subjects of the study that is capable of influencing individual perceptions of quality of life. RESULTS: This study will attempt to identify variables (and their temporal trend) that can be attributed to the family unit and—together with physical and clinical variables—that may influence the quality of life of children with congenital heart disease. CONCLUSION: Examining family quality of life with the longitudinal method will allow us to identify the predictors and interdependence of this factor with respect to children and their parents. This will help to correct and elaborate upon care guidelines, providing better assistance to patients and their caregivers.
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Affiliation(s)
- Silvio Simeone
- Clinical and Experimental Medicine Department, “Magna Graecia” University, 88100 Catanzaro, Italy;
| | - Teresa Rea
- Public Health Department, Federico II University Hospital, 80131 Naples, Italy;
| | - Nicol Platone
- Gaetano Pasquinucci Heart Hospital, 54100 Massa, Italy; (N.P.); (N.A.); (P.D.V.); (S.B.)
| | - Assunta Guillari
- Department of Public Health, University Federico II of Naples, 80145 Napoli, Italy
- Correspondence:
| | | | - Nadia Assanta
- Gaetano Pasquinucci Heart Hospital, 54100 Massa, Italy; (N.P.); (N.A.); (P.D.V.); (S.B.)
| | - Paola Da Valle
- Gaetano Pasquinucci Heart Hospital, 54100 Massa, Italy; (N.P.); (N.A.); (P.D.V.); (S.B.)
| | - Stefania Baratta
- Gaetano Pasquinucci Heart Hospital, 54100 Massa, Italy; (N.P.); (N.A.); (P.D.V.); (S.B.)
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevenion, University of Rome Tor Vergata, 00133 Rome, Italy;
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Parikh KJ, Fundora MP, Sasaki N, Rossi AF, Burke RP, Sasaki J. Use of aortic arch measurements in evaluating significant arch hypoplasia in neonates with coarctation. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lelong N, Tararbit K, Le Page‐Geniller L, Cohen J, Kout S, Foix‐L'Hélias L, Boileau P, Chalumeau M, Goffinet F, Khoshnood B. Predicting the risk of infant mortality for newborns operated for congenital heart defects: A population-based cohort (EPICARD) study of two post-operative predictive scores. Health Sci Rep 2021; 4:e300. [PMID: 34027127 PMCID: PMC8133834 DOI: 10.1002/hsr2.300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/30/2021] [Accepted: 04/15/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Whereas no global severity score exists for congenital heart defects (CHD), risk (Risk Adjusted Cardiac Heart Surgery-1: RACHS-1) and/or complexity (Aristotle Basic Complexity: ABC) scores have been developed for those who undergo surgery. Population-based studies for assessing the predictive ability of these scores are lacking. OBJECTIVE To assess the predictive ability of RACHS-1 and ABC scores for the risk of infant mortality using population-based cohort (EPICARD) data for newborns with structural CHD. METHODS The study population comprised 443 newborns who underwent curative surgery. We assessed the predictive ability of each score alone and in conjunction with an a priori selected set of predictors of infant mortality. Statistical analysis included logistic regression models for which we computed model calibration, discrimination (ROC), and a rarely used but clinically meaningful measure of variance explained (Tjur's coefficient of discrimination). RESULTS The risk of mortality increased with increasing RACHS-1 and the ABC scores and models based on both scores had adequate calibration. Model discrimination was higher for the RACHS-1-based model (ROC 0.68, 95% CI, 0.58-0.79) than the ABC-based one (ROC 0.59, 95% CI, 0.49-0.69), P = 0.03. Neither score had the good predictive ability when this was assessed using Tjur's coefficient. CONCLUSIONS Even if the RACHS-1 score had better predictive ability, both scores had low predictive ability using a variance-explained measure. Because of this limitation and the fact that neither score can be used for newborns with CHD who do not undergo surgery, it is important to develop new predictive models that comprise all newborns with structural CHD.
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Affiliation(s)
- Nathalie Lelong
- INSERM Obstetrical, Perinatal and Pediatric Epidemiology Research TeamUniversité de Paris, CRESSParisFrance
| | - Karim Tararbit
- INSERM Obstetrical, Perinatal and Pediatric Epidemiology Research TeamUniversité de Paris, CRESSParisFrance
| | | | - Jérémie Cohen
- INSERM Obstetrical, Perinatal and Pediatric Epidemiology Research TeamUniversité de Paris, CRESSParisFrance
- Department of General Pediatrics and Pediatric Infectious DiseasesAP‐HP, Hôpital Necker ‐ Enfants malades, Université de ParisParisFrance
| | - Souad Kout
- Department of NeonatologyCHI André GrégoireMontreuilFrance
| | - Laurence Foix‐L'Hélias
- INSERM Obstetrical, Perinatal and Pediatric Epidemiology Research TeamUniversité de Paris, CRESSParisFrance
- Department of Neonatology, Hôpital Armand Trousseau, Assistance Publique‐Hôpitaux de ParisMedecine Sorbonne UniversityParisFrance
| | - Pascal Boileau
- Department of NeonatologyCHI Poissy Saint‐Germain‐en‐LayePoissyFrance
| | - Martin Chalumeau
- INSERM Obstetrical, Perinatal and Pediatric Epidemiology Research TeamUniversité de Paris, CRESSParisFrance
- Department of General Pediatrics and Pediatric Infectious DiseasesAP‐HP, Hôpital Necker ‐ Enfants malades, Université de ParisParisFrance
| | - François Goffinet
- INSERM Obstetrical, Perinatal and Pediatric Epidemiology Research TeamUniversité de Paris, CRESSParisFrance
- Port‐Royal Maternity UnitCochin University Hospital, Assistance Publique Hôpitaux de ParisParisFrance
| | - Babak Khoshnood
- INSERM Obstetrical, Perinatal and Pediatric Epidemiology Research TeamUniversité de Paris, CRESSParisFrance
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Zhang QL, Xu N, Huang ST, Cao H, Chen Q. WeChat-assisted pre-operative health education improves the quality of life of parents of children with ventricular septal defects: A prospective randomised controlled study. J Paediatr Child Health 2021; 57:664-669. [PMID: 33656232 DOI: 10.1111/jpc.15307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/09/2020] [Accepted: 11/17/2020] [Indexed: 11/27/2022]
Abstract
AIM This study aimed to explore the effect of implementing pre-operative WeChat-assisted health education for parents of children with restrictive ventricular septal defects to improve their quality of life. METHODS A prospective randomised controlled study was conducted in a provincial hospital in China. Participants were randomly divided into the intervention group (WeChat group, n = 35) and the control group (leaflet group, n = 35). The quality of life of parents of children with restricted ventricular septal defects was studied. RESULTS Compared with the leaflet group, the WeChat group had a significantly lower score for the pre-operative Self-Rating Anxiety Scale (SAS) (P < 0.05). The pre-operative SAS score in the WeChat group was significantly lower than that at the first visit (P < 0.05). However, the SAS score in the leaflet group was similar at the time of preoperation and the first visit (P > 0.05). The pre-operative scores of the World Health Organization Quality of Life-BREF (WHOQOL-BREF) scale in the physiological, psychological, social, and environmental fields and the total life quality score in the WeChat group were significantly higher than those of the leaflet group (P < 0.05). CONCLUSION Implementing pre-operative WeChat-assisted health education for parents of children with restrictive ventricular septal defects can effectively relieve their anxiety and improve their quality of life.
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Affiliation(s)
- Qi-Liang Zhang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ning Xu
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Shu-Ting Huang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
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Associations Between Postoperative Management in the Critical Care Unit and Adolescent Developmental Outcomes Following Cardiac Surgery in Infancy: An Exploratory Study. Pediatr Crit Care Med 2020; 21:e1010-e1019. [PMID: 32639471 DOI: 10.1097/pcc.0000000000002398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Children with congenital heart disease are at high risk for developmental sequelae. Most studies focus on preoperative and intraoperative predictors of developmental impairment, with less attention to the postoperative period. The relationship between patient-related factors specific to the postoperative course in the PICU following cardiac surgery with long-term neurodevelopmental outcomes in adolescence was examined. DESIGN Retrospective chart review of patients previously recruited to a study describing their developmental outcomes in adolescence. SETTING Single tertiary care pediatric hospital in Canada. PATIENTS Eighty adolescents, born between 1991 and 1999, with congenital heart disease who required open-heart surgery before 2 years old. MEASUREMENTS AND MAIN RESULTS Several variables related to acuity of illness and complexity of postoperative course in the PICU were collected. Outcome measures included the Movement-Assessment Battery for Children-2 (motor), Leiter Brief Intelligence Quotient (cognition), and Strength and Difficulties Questionnaire (behavior). Analyses examined associations between PICU variables and long-term outcomes. Longer mechanical ventilation (β = -0.49; p = 0.013) and dopamine use (β = -14.41; p = 0.012) were associated with lower motor scores. Dopamine use was associated with lower cognitive scores (β = -14.02; p = 0.027). Longer PICU stay (β = 0.18; p = 0.002), having an open chest postoperatively (β = 3.83; p = 0.017), longer mechanical ventilation (β = 0.20; p = 0.001), longer inotrope support (β = 0.27; p = 0.002), hours on dopamine (β = 0.01; p = 0.007), days to enteral feeding (β = 0.22; p = 0.012), lower hemoglobin (β = -0.11; p = 0.004), and higher creatinine (β = 0.05; p = 0.014) were all associated with behavioral difficulties. CONCLUSIONS Several important developmental outcomes in adolescents were associated with factors related to their postoperative course in the PICU as infants. Findings may highlight those children at highest risk for neurodevelopmental sequelae and suggest new approaches to critical care management following open-heart surgery, with the aim of mitigating or preventing adverse long-term outcomes.
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Combs CA, Hameed AB, Friedman AM, Hoskins IA, Friedman AM, Hoskins IA. Special statement: Proposed quality metrics to assess accuracy of prenatal detection of congenital heart defects. Am J Obstet Gynecol 2020; 222:B2-B9. [PMID: 32114082 DOI: 10.1016/j.ajog.2020.02.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Congenital heart defects are a leading cause of neonatal morbidity and mortality. Accurate prenatal diagnosis of congenital heart defects can reduce morbidity and mortality by improving prenatal care, facilitating predelivery pediatric cardiology consultation, and directing delivery to facilities with resources to manage the complex medical and surgical needs of newborns with congenital heart defects. Unfortunately, less than one half of congenital heart defect cases are detected prenatally, resulting in lost opportunities for counseling, shared decision-making, and delivery at an appropriate facility. Quality improvement initiatives to improve prenatal congenital heart defects detection depend on the ability to measure the rate of detection at the level of providers, facilities, or populations, but no standard metric exists for measuring the detection of congenital heart defects at any level. The need for such a metric was recognized at a Cooperative Workshop held at the 2016 Annual Meeting of the Society for Maternal-Fetal Medicine, which recommended the development of a quality metric to assess the rate of prenatal detection of clinically significant congenital heart defects. In this paper, we propose potential quality metrics to measure prenatal detection of critical congenital heart defects, defined as defects with a high rate of morbidity or mortality or that require surgery or tertiary follow-up. One metric is based on a retrospective approach, assessing whether postnatally diagnosed congenital heart defects had been identified prenatally. Other metrics are based on a prospective approach, assessing the sensitivity and specificity of prenatal diagnosis of congenital heart defects by comparing prenatal ultrasound findings with newborn findings. Potential applications, limitations, challenges, barriers, and value for both approaches are discussed. We conclude that future development of these metrics will depend on an expansion of the International Classification of Diseases system to include specific codes that distinguish fetal congenital heart defects from newborn congenital heart defects and on the development of record systems that facilitate the linkage of fetal records (in the maternal chart) with newborn records.
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12
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Fourdain S, Caron-Desrochers L, Simard MN, Provost S, Doussau A, Gagnon K, Dagenais L, Presutto É, Prud'homme J, Boudreault-Trudeau A, Constantin IM, Desnous B, Poirier N, Gallagher A. Impacts of an Interdisciplinary Developmental Follow-Up Program on Neurodevelopment in Congenital Heart Disease: The CINC Study. Front Pediatr 2020; 8:539451. [PMID: 33123502 PMCID: PMC7573208 DOI: 10.3389/fped.2020.539451] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 08/18/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study investigates the impact of an early systematic interdisciplinary developmental follow-up and individualized intervention program on the neurodevelopment of children with complex congenital heart disease (CHD) who required cardiac surgery. Study Design: We prospectively enrolled 80 children with CHD: 41 were already followed at our neurocardiac developmental follow-up clinic from the age of 4 months, while 39 were born before the establishment of the program and therefore received standard health care. We conducted cognitive, motor, and behavioral assessments at 3 years of age. We used one-way multivariate analyses of variance to compare the neurodevelopmental outcome of both groups. Results: Between-group analyses revealed a distinct neurodevelopmental profile with clinically significant effect size (P < 0.001, partial η2 = 0.366). Children followed at our clinic demonstrated better receptive language performances (P = 0.048) and tended to show higher scores on visuo-constructive tasks (P = 0.080). Children who received standard health care exhibited greater performances in working memory tasks (P = 0.032). We found no group differences on global intellectual functioning, gross and fine motor skills, and behaviors. Referral rates for specific remedial services were higher in patients followed at our neurocardiac clinic compared to the historical cohort (P < 0.005). Conclusions: Overall, the impact of the developmental follow-up and individualized intervention program on neurodevelopmental outcomes remains subtle. Nevertheless, results, although limited by several factors, point toward an advantage for the children who took part in the program regarding receptive language skills over children who received standard health care. We hypothesize that group differences may be greater with growing age. Further research involving larger cohorts is needed to clearly assess the effectiveness of neurocardiac developmental follow-up programs at school age.
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Affiliation(s)
- Solène Fourdain
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Laura Caron-Desrochers
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Marie-Noëlle Simard
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,School of Rehabilitation, Université de Montréal, Montreal, QC, Canada.,Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Sarah Provost
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Amélie Doussau
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Karine Gagnon
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Lynn Dagenais
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Émilie Presutto
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Joëlle Prud'homme
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | | | - Ioana Medeleine Constantin
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Béatrice Desnous
- Division of Neurology, Department of Pediatrics, La Timone Hospital, Marseille, France
| | - Nancy Poirier
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Anne Gallagher
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada.,Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
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13
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Schlapbach LJ, Horton SB, Long DA, Beca J, Erickson S, Festa M, d’Udekem Y, Alphonso N, Winlaw D, Johnson K, Delzoppo C, van Loon K, Gannon B, Fooken J, Blumenthal A, Young P, Jones M, Butt W, Schibler A. Study protocol: NITric oxide during cardiopulmonary bypass to improve Recovery in Infants with Congenital heart defects (NITRIC trial): a randomised controlled trial. BMJ Open 2019; 9:e026664. [PMID: 31420383 PMCID: PMC6701583 DOI: 10.1136/bmjopen-2018-026664] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Congenital heart disease (CHD) is a major cause of infant mortality. Many infants with CHD require corrective surgery with most operations requiring cardiopulmonary bypass (CPB). CPB triggers a systemic inflammatory response which is associated with low cardiac output syndrome (LCOS), postoperative morbidity and mortality. Delivery of nitric oxide (NO) into CPB circuits can provide myocardial protection and reduce bypass-induced inflammation, leading to less LCOS and improved recovery. We hypothesised that using NO during CPB increases ventilator-free days (VFD) (the number of days patients spend alive and free from invasive mechanical ventilation up until day 28) compared with standard care. Here, we describe the NITRIC trial protocol. METHODS AND ANALYSIS The NITRIC trial is a randomised, double-blind, controlled, parallel-group, two-sided superiority trial to be conducted in six paediatric cardiac surgical centres. One thousand three-hundred and twenty infants <2 years of age undergoing cardiac surgery with CPB will be randomly assigned to NO at 20 ppm administered into the CPB oxygenator for the duration of CPB or standard care (no NO) in a 1:1 ratio with stratification by age (<6 and ≥6 weeks), single ventricle physiology (Y/N) and study centre. The primary outcome will be VFD to day 28. Secondary outcomes include a composite of LCOS, need for extracorporeal membrane oxygenation or death within 28 days of surgery; length of stay in intensive care and in hospital; and, healthcare costs. Analyses will be conducted on an intention-to-treat basis. Preplanned secondary analyses will investigate the impact of NO on host inflammatory profiles postsurgery. ETHICS AND DISSEMINATION The study has ethical approval (HREC/17/QRCH/43, dated 26 April 2017), is registered in the Australian New Zealand Clinical Trials Registry (ACTRN12617000821392) and commenced recruitment in July 2017. The primary manuscript will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ACTRN12617000821392.
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Affiliation(s)
- Luregn J Schlapbach
- Paediatric Critical Care Research Group, Child Health Research Institute, The University of Queensland, Brisbane, Queensland, Australia
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, Children’s Health Queensland, Brisbane, Queensland, Australia
| | - Stephen Brian Horton
- Cardiac Surgical Unit, Royal Children’s Hospital, Melbourne, Victoria, Australia
- Faculty of Medicine, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Debbie Amanda Long
- Paediatric Critical Care Research Group, Child Health Research Institute, The University of Queensland, Brisbane, Queensland, Australia
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, Children’s Health Queensland, Brisbane, Queensland, Australia
| | - John Beca
- Paediatric Intensive Care Unit, Starship Children’s Hospital, Auckland, New Zealand
| | - Simon Erickson
- Paediatric Critical Care, Perth Children’s Hospital, Western Australia and The University of Western Australia, Crawley, Western Australia, Australia
| | - Marino Festa
- Kids Critical Care Research, Paediatric Intensive Care Unit, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- Sydney Children’s Hospital Network, Sydney, New South Wales, Australia
| | - Yves d’Udekem
- Department of Cardiac Surgery, Royal Children’s Hospital, Melbourne, Victoria, Australia
- Heart Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- School of Medicine, Children’s Health Clinical Unit, University of Queensland, Brisbane, Queensland, Australia
| | - Nelson Alphonso
- Cardiac Surgery, Queensland Children’s Hospital, Brisbane, Queensland, Australia
| | - David Winlaw
- Heart Centre for Children, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- Sydney Children’s Hospital Network and Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kerry Johnson
- Paediatric Critical Care Research Group, Child Health Research Institute, The University of Queensland, Brisbane, Queensland, Australia
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, Children’s Health Queensland, Brisbane, Queensland, Australia
| | - Carmel Delzoppo
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Paediatric Intensive Care Unit, Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia
| | - Kim van Loon
- Division of Anaesthetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B Gannon
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Jonas Fooken
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Antje Blumenthal
- The Infection and Inflammation Group, The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia
| | - Paul Young
- The Intensive Care Research Programme, Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Mark Jones
- School of Public Health, Bond University, Gold Coast, Brisbane, Australia
| | - Warwick Butt
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Paediatric Intensive Care Unit, Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia
| | - Andreas Schibler
- Paediatric Critical Care Research Group, Child Health Research Institute, The University of Queensland, Brisbane, Queensland, Australia
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, Children’s Health Queensland, Brisbane, Queensland, Australia
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15
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Feng Y, Cai J, Tong X, Chen R, Zhu Y, Xu B, Mo X. Non-inheritable risk factors during pregnancy for congenital heart defects in offspring: A matched case-control study. Int J Cardiol 2018; 264:45-52. [PMID: 29685690 DOI: 10.1016/j.ijcard.2018.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/04/2018] [Accepted: 04/02/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Yu Feng
- Department of Thoracic Surgery, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China; Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
| | - Jun Cai
- Ministry of Education Key Laboratory for Earth System Modelling, Department of Earth System Science, Tsinghua University, Beijing 100084, China; Joint Center for Global Change Studies, Beijing 100875, China
| | - Xing Tong
- Department of Pathology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Runsen Chen
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
| | - Yu Zhu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
| | - Bing Xu
- Ministry of Education Key Laboratory for Earth System Modelling, Department of Earth System Science, Tsinghua University, Beijing 100084, China; Joint Center for Global Change Studies, Beijing 100875, China.
| | - Xuming Mo
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China.
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16
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Desai J, Aggarwal S, Lipshultz S, Agarwal P, Yigazu P, Patel R, Seals S, Natarajan G. Surgical Interventions in Infants Born Preterm with Congenital Heart Defects: An Analysis of the Kids' Inpatient Database. J Pediatr 2017; 191:103-109.e4. [PMID: 28964428 DOI: 10.1016/j.jpeds.2017.07.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 06/16/2017] [Accepted: 07/07/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate short-term outcomes in infants born preterm with congenital heart defects (CHDs) and the factors associated with surgery, survival, and length of hospitalization in this population. STUDY DESIGN We analyzed data from infants born preterm (gestational age <37 weeks) enrolled in the multicenter Kids' Inpatient Database of the Healthcare Cost and Utilization Project who were admitted to the hospital within 30 days after birth. Infants with atrial septal defects were excluded. RESULTS Of 1 429 762 enrolled infants born preterm, 27 434 (2.0%) with CHDs were included. Overall survival to discharge was 90.5%; 74.0% among infants with critical CHDs and 45.7% among infants with hypoplastic left heart syndrome. Cardiac surgeries were performed in 12.2% of all infants born preterm. Rates of surgical intervention for infants with critical CHDs were lower for very low birth weight (≤1.5 kg) vs larger infants >1.5 kg (27% vs 44%), and only 6.3% of infants born with very low birth weight underwent surgeries in Risk-adjustment for Congenital Heart Surgery categories 4 or greater. Greater birth weight, left-sided lesions, care at children's hospitals, and absence of trisomies were associated with a greater likelihood of surgery. Birth weight <2 kg, nonwhite race, trisomy syndromes, prematurity-related morbidities, and Risk-adjustment for Congenital Heart Surgery category 4 or greater were independent predictors of mortality. Birth weight <2 kg, Risk-adjustment for Congenital Heart Surgery category, morbidities, and sidedness of lesion predicted length of stay. CONCLUSIONS The high survival rates of infants born preterm with CHDs suggests that a cautiously optimistic approach to surgery may be warranted in all but the most immature infants with the greatest-risk conditions.
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Affiliation(s)
- Jagdish Desai
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS; Division of Neonatology, Children's Hospital of Michigan, Wayne State University, Detroit, MI.
| | - Sanjeev Aggarwal
- Division of Pediatric Cardiology, Children's Hospital of Michigan, Wayne State University, Detroit, MI
| | - Steven Lipshultz
- Division of Pediatric Cardiology, Children's Hospital of Michigan, Wayne State University, Detroit, MI
| | - Prashant Agarwal
- Division of Neonatology, Children's Hospital of Michigan, Wayne State University, Detroit, MI
| | - Paulos Yigazu
- Division of Neonatology, Children's Hospital of Michigan, Wayne State University, Detroit, MI
| | - Riddhiben Patel
- Division of Child Neurology, University of Mississippi Medical Center, Jackson, MS
| | - Samantha Seals
- Center of Biostatistics & Bioinformatics, University of Mississippi Medical Center, Jackson, MS
| | - Girija Natarajan
- Division of Neonatology, Children's Hospital of Michigan, Wayne State University, Detroit, MI
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17
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Gallagher A, Dagenais L, Doussau A, Décarie JC, Materassi M, Gagnon K, Prud'homme J, Vobecky S, Poirier N, Carmant L. Significant motor improvement in an infant with congenital heart disease and a rolandic stroke: The impact of early intervention. Dev Neurorehabil 2017; 20:165-168. [PMID: 26889873 DOI: 10.3109/17518423.2015.1132280] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To report the impact of early motor intervention in an infant with congenital heart disease (CHD) and a stroke. METHODS AND RESULTS A 35-week newborn with a complex CHD and a normal MRI presented with early motor developmental delay at 2 months. She began an intervention program, which included biweekly motor developmental therapy with a physiotherapist, parental education, and daily home exercises. At 4 months, she underwent cardiac surgery. Following surgery, she was diagnosed with a stroke involving the right sylvian artery territory. She continued her intensive intervention program. The 12-month assessment revealed an evident gain of motor function. Despite MRI evidence of a chronic infarct involving the primary motor cortex, the child had normal motor functions. CONCLUSION This case report supports the positive impact of early intervention in infants with CHD and its potential effect on enhancing neuroplasticity, even in children with cerebro-vascular accidents involving areas of motor function.
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Affiliation(s)
- Anne Gallagher
- a CHU Sainte-Justine Research Centre, University of Montreal , Montréal , Canada
| | - Lynn Dagenais
- b Clinique Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine , Montréal , Canada
| | - Amélie Doussau
- b Clinique Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine , Montréal , Canada
| | - Jean-Claude Décarie
- c Department of Radiology , CHU Sainte-Justine, University of Montreal , Montréal , Canada
| | - Manuela Materassi
- b Clinique Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine , Montréal , Canada
| | - Karine Gagnon
- b Clinique Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine , Montréal , Canada
| | - Joelle Prud'homme
- b Clinique Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine , Montréal , Canada
| | - Suzanne Vobecky
- b Clinique Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine , Montréal , Canada
| | - Nancy Poirier
- b Clinique Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine , Montréal , Canada
| | - Lionel Carmant
- a CHU Sainte-Justine Research Centre, University of Montreal , Montréal , Canada.,b Clinique Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine , Montréal , Canada
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18
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Bhalala US, Appachi E, Mumtaz MA. Neurologic Injury Associated with Rewarming from Hypothermia: Is Mild Hypothermia on Bypass Better than Deep Hypothermic Circulatory Arrest? Front Pediatr 2016; 4:104. [PMID: 27734011 PMCID: PMC5039167 DOI: 10.3389/fped.2016.00104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/07/2016] [Indexed: 11/13/2022] Open
Abstract
Many known risk factors for adverse cardiovascular and neurological outcomes in children with congenital heart defects (CHD) are not modifiable; however, the temperature and blood flow during cardiopulmonary bypass (CPB), are two risk factors, which may be altered in an attempt to improve long-term neurological outcomes. Deep hypothermic circulatory arrest, traditionally used for aortic arch repair, has been associated with short-term and long-term neurologic sequelae. Therefore, there is a rising interest in using moderate hypothermia with selective antegrade cerebral blood flow on CPB during aortic arch repair. Rewarming from moderate-to-deep hypothermia has been shown to be associated with neuronal injury, neuroinflammation, and loss of cerebrovascular autoregulation. A significantly lesser degree of rewarming is required following mild (33-35°C) hypothermia as compared with moderate (28-32°C), deep (21-27°C), and profound (less than 20°C) hypothermia. Therefore, we believe that mild hypothermia is associated with a lower risk of rewarming-induced neurologic injury. We hypothesize that mild hypothermia with selective antegrade cerebral perfusion during CPB for neonatal aortic arch repair would be associated with improved neurologic outcome.
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Affiliation(s)
- Utpal S Bhalala
- Children's Hospital of San Antonio, Baylor College of Medicine , San Antonio, TX , USA
| | - Elumalai Appachi
- Children's Hospital of San Antonio, Baylor College of Medicine , San Antonio, TX , USA
| | - Muhammad Ali Mumtaz
- Children's Hospital of San Antonio, Baylor College of Medicine , San Antonio, TX , USA
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Abstract
Supplemental Digital Content is available in the text. Objective: Inflammation and metabolism are closely interlinked. Both undergo significant dysregulation following surgery for congenital heart disease, contributing to organ failure and morbidity. In this study, we combined cytokine and metabolic profiling to examine the effect of postoperative tight glycemic control compared with conventional blood glucose management on metabolic and inflammatory outcomes in children undergoing congenital heart surgery. The aim was to evaluate changes in key metabolites following congenital heart surgery and to examine the potential of metabolic profiling for stratifying patients in terms of expected clinical outcomes. Design: Laboratory and clinical study. Setting: University Hospital and Laboratory. Patients: Of 28 children undergoing surgery for congenital heart disease, 15 underwent tight glycemic control postoperatively and 13 were treated conventionally. Interventions: Metabolic profiling of blood plasma was undertaken using proton nuclear magnetic resonance spectroscopy. A panel of metabolites was measured using a curve-fitting algorithm. Inflammatory cytokines were measured by enzyme-linked immunosorbent assay. The data were assessed with respect to clinical markers of disease severity (Risk Adjusted Congenital heart surgery score-1, Pediatric Logistic Organ Dysfunction, inotrope score, duration of ventilation and pediatric ICU-free days). Measurements and Main Results: Changes in metabolic and inflammatory profiles were seen over the time course from surgery to recovery, compared with the preoperative state. Tight glycemic control did not significantly alter the response profile. We identified eight metabolites (3-d-hydroxybutyrate, acetone, acetoacetate, citrate, lactate, creatine, creatinine, and alanine) associated with surgical and disease severity. The strength of proinflammatory response, particularly interleukin-8 and interleukin-6 concentrations, inversely correlated with PICU-free days at 28 days. The interleukin-6/interleukin-10 ratio directly correlated with plasma lactate. Conclusions: This is the first report on the metabolic response to cardiac surgery in children. Using nuclear magnetic resonance to monitor the patient journey, we identified metabolites whose concentrations and trajectory appeared to be associated with clinical outcome. Metabolic profiling could be useful for patient stratification and directing investigations of clinical interventions.
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20
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O'Brien P, Evangelista JA, Green A, Uzark K. Health considerations for children with congenital heart disease in school: part 1. NASN Sch Nurse 2012. [PMID: 23193726 DOI: 10.1177/1942602x12450737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
School participation for children with congenital heart disease (CHD) can be challenging. Despite advances in treatment that have increased survival to adulthood and decreased morbidity, concerns remain about their health and safety in the school environment. This article, the first in a two-part series, provides an overview of the health issues involving school-age children with CHD. School nurses are in a unique position to advocate for the child's health care needs in the school setting, facilitate communication with the health care team, educate school personnel, and participate in the individualized educational planning process.
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Pappas A, Shankaran S, Hansen NI, Bell EF, Stoll BJ, Laptook AR, Walsh MC, Das A, Bara R, Hale EC, Newman NS, Boghossian NS, Murray JC, Cotten CM, Adams-Chapman I, Hamrick S, Higgins RD. Outcome of extremely preterm infants (<1,000 g) with congenital heart defects from the National Institute of Child Health and Human Development Neonatal Research Network. Pediatr Cardiol 2012; 33:1415-26. [PMID: 22644414 PMCID: PMC3687358 DOI: 10.1007/s00246-012-0375-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 05/08/2012] [Indexed: 10/28/2022]
Abstract
Little is known about the outcomes of extremely low birth weight (ELBW) preterm infants with congenital heart defects (CHDs). The aim of this study was to assess the mortality, morbidity, and early childhood outcomes of ELBW infants with isolated CHD compared with infants with no congenital defects. Participants were 401-1,000 g infants cared for at National Institute of Child Health and Human Development Neonatal Research Network centers between January 1, 1998, and December 31, 2005. Neonatal morbidities and 18-22 months' corrected age outcomes were assessed. Neurodevelopmental impairment (NDI) was defined as moderate to severe cerebral palsy, Bayley II mental or psychomotor developmental index <70, bilateral blindness, or hearing impairment requiring aids. Poisson regression models were used to estimate relative risks for outcomes while adjusting for gestational age, small-for-gestational-age status, and other variables. Of 14,457 ELBW infants, 110 (0.8 %) had isolated CHD, and 13,887 (96 %) had no major birth defect. The most common CHD were septal defects, tetralogy of Fallot, pulmonary valve stenosis, and coarctation of the aorta. Infants with CHD experienced increased mortality (48 % compared with 35 % for infants with no birth defect) and poorer growth. Surprisingly, the adjusted risks of other short-term neonatal morbidities associated with prematurity were not significantly different. Fifty-seven (52 %) infants with CHD survived to 18-22 months' corrected age, and 49 (86 %) infants completed follow-up. A higher proportion of surviving infants with CHD were impaired compared with those without birth defects (57 vs. 38 %, p = 0.004). Risk of death or NDI was greater for ELBW infants with CHD, although 20 % of infants survived without NDI.
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Affiliation(s)
- Athina Pappas
- Department of Pediatrics, Children's Hospital of Michigan and Hutzel Women's Hospital, Wayne State University, 3901 Beaubien, Detroit, MI 48201, USA.
| | | | - Nellie I. Hansen
- Statistics and Epidemiology Unit, RTI International, Research Triangle Park, NC
| | - Edward F. Bell
- Department of Pediatrics, University of Iowa Children’s Hospital, Iowa City, IA
| | - Barbara J. Stoll
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA
| | - Abbot R. Laptook
- Department of Pediatrics, Women & Infants’ Hospital, Brown University, Providence, RI
| | - Michele C. Walsh
- Department of Pediatrics, Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH
| | - Abhik Das
- Statistics and Epidemiology Unit, RTI International, Rockville, MD
| | - Rebecca Bara
- Department of Pediatrics, Wayne State University, Detroit, MI
| | - Ellen C. Hale
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA
| | - Nancy S. Newman
- Department of Pediatrics, Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH
| | - Nansi S. Boghossian
- Department of Pediatrics, University of Iowa Children’s Hospital, Iowa City, IA
| | - Jeffrey C. Murray
- Department of Pediatrics, University of Iowa Children’s Hospital, Iowa City, IA
| | | | - Ira Adams-Chapman
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA
| | - Shannon Hamrick
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA
| | - Rosemary D. Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
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Laas E, Lelong N, Thieulin AC, Houyel L, Bonnet D, Ancel PY, Kayem G, Goffinet F, Khoshnood B. Preterm birth and congenital heart defects: a population-based study. Pediatrics 2012; 130:e829-37. [PMID: 22945415 DOI: 10.1542/peds.2011-3279] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Preterm birth (PTB) and congenital heart defect (CHD) are 2 major causes of mortality and disability of perinatal origin. There are limited data on the relation between CHD and PTB. Our objective was to use population-based data to estimate the risk of PTB in newborns with CHD and to study specific associations between categories of CHD and PTB. METHODS We used data from a population-based cohort study of CHD (EPIdémiologique sur le devenir des enfants porteurs de CARDiopathies congénitales study), including 2189 live births with CHD (excluding isolated atrial septal defects) born between 2005 and 2008. We categorized CHD by using an anatomic and clinical classification. Data from the French National Perinatal Survey of 2003 were used to compare PTB in the EPIdémiologique sur le devenir des enfants porteurs de CARDiopathies congénitales study to that of the general population. RESULTS Of the newborns with CHD, 13.5% were preterm. The odds of PTB were twofold higher than for the general population (odds ratio 2.0, 95% confidence interval 1.6-2.5), essentially due to an increase in spontaneous PTB for newborns with CHD. The risk of PTB associated with CHD persisted after exclusion of chromosomal or other anomalies. There were significant variations in risk of PTB across the categories of CHD after adjustment for known risk factors of PTB and factors related to medical management of pregnancy and delivery. CONCLUSIONS We found a higher risk of PTB in newborns with CHD, which was essentially due to spontaneous PTB. Risk of PTB varied for categories of CHD. Our finding may be helpful for generating hypotheses about the developmental links between CHD and PTB.
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Affiliation(s)
- Enora Laas
- INSERM UMR S953, Recherche Épidémiologique sur la Santé Périnatale et la Santé des Femmes et des Enfants, UPMC, Université Paris-6, Paris, France.
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Lee JK, Blaine Easley R, Brady KM. Neurocognitive monitoring and care during pediatric cardiopulmonary bypass-current and future directions. Curr Cardiol Rev 2011; 4:123-39. [PMID: 19936287 PMCID: PMC2779352 DOI: 10.2174/157340308784245766] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 12/17/2007] [Accepted: 12/21/2007] [Indexed: 11/22/2022] Open
Abstract
Neurologic injury in patients with congenital heart disease remains an important source of morbidity and mortality. Advances in surgical repair and perioperative management have resulted in longer life expectancies for these patients. Current practice and research must focus on identifying treatable risk factors for neurocognitive dysfunction, advancing methods for perioperative neuromonitoring, and refining treatment and care of the congenital heart patient with potential neurologic injury. Techniques for neuromonitoring and future directions will be discussed.
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Affiliation(s)
- Jennifer K Lee
- Departments of Anesthesiology/Critical Care Medicine and Pediatrics, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Sable C, Foster E, Uzark K, Bjornsen K, Canobbio MM, Connolly HM, Graham TP, Gurvitz MZ, Kovacs A, Meadows AK, Reid GJ, Reiss JG, Rosenbaum KN, Sagerman PJ, Saidi A, Schonberg R, Shah S, Tong E, Williams RG. Best Practices in Managing Transition to Adulthood for Adolescents With Congenital Heart Disease: The Transition Process and Medical and Psychosocial Issues. Circulation 2011; 123:1454-85. [DOI: 10.1161/cir.0b013e3182107c56] [Citation(s) in RCA: 317] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Natural and unnatural history of tetralogy of Fallot repaired during adolescence and adulthood. Heart Vessels 2011; 27:65-70. [DOI: 10.1007/s00380-011-0119-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 01/14/2011] [Indexed: 11/26/2022]
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Hoskoppal A, Roberts H, Kugler J, Duncan K, Needelman H. Neurodevelopmental outcomes in infants after surgery for congenital heart disease: a comparison of single-ventricle vs. two-ventricle physiology. CONGENIT HEART DIS 2010; 5:90-5. [PMID: 20412480 DOI: 10.1111/j.1747-0803.2009.00373.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The neurodevelopmental outcome of children with repaired congenital heart defect has risen in importance with improved survival. This study compares neurodevelopmental outcomes of children who had CHD with single ventricle physiology with those who had CHD with two-ventricle physiology. PATIENTS AND METHODS Participants included 112 infants discharged from the NICU between February 1999 to August 2006. The 12 infants who had a known genetic defect were excluded. Of the 100 infants 26 had single ventricle physiology and 74 had CHD with two-ventricle physiology. The children were seen in a follow-up clinic and growth parameters and standardized instruments were used to evaluate development. The referral rate to early intervention services was also compared. RESULTS The number of functional ventricles did not significantly differentiate growth parameters at 6-8 months of age. Early cognitive outcomes were relatively unimpaired in both the groups (single ventricle vs. two ventricle physiology). Early motor outcomes were worse in (p < 0.05) CHD with single ventricle physiology. The rate of referral for early intervention services was high in both groups compared to the average rate of referral in the state, but there was not a significant difference between the CHD groups. CONCLUSION Significant differences noted on motor outcomes at the 6-8 month visit were no longer apparent in later visits. Referral to early intervention services is high in both the groups. These findings are important to those caring for infants with CHD because many of these patients may need referral for early intervention.
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Affiliation(s)
- Arvind Hoskoppal
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE 68198-5380, USA
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A new look at outcomes of infants with congenital heart disease. Pediatr Neurol 2009; 40:197-204. [PMID: 19218033 DOI: 10.1016/j.pediatrneurol.2008.09.014] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 08/07/2008] [Accepted: 08/07/2008] [Indexed: 11/23/2022]
Abstract
This article provides an overview of a longitudinal study on a cohort of 131 newborns and young infants with congenital heart defects who required open heart surgery. The rationale for the study design is provided as well as a summary of the procedures used to evaluate these children prior to surgery, at discharge after surgery, 12-18 months later, and at 5 years of age. Results demonstrate that a substantial proportion of these infants had neurologic and developmental abnormalities prior to surgical repair. Developmental delays were common in children with both cyanotic and acyanotic heart defects, and these deficits persisted to school entry. A number of medical, surgical, demographic and environmental factors were significantly associated with developmental outcomes suggesting a multifactorial etiology to brain injury. Limited educational and rehabilitation resources for this cohort at early school age suggests that service needs may need to be more carefully planned for this high-risk population. Lessons learnt from this prospective study are highlighted as well as future directions for research and clinical practice.
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Abstract
Despite a widespread myth of parental autonomy in decision-making for extremely preterm neonates, families in the United States are often not given access to accurate information about the consequences of preterm birth, resuscitation and treatment, or about their ethical options. Professional, philosophical, and financial incentives for hospitals and neonatologists to provide intensive treatment may trump parental wishes in delivery rooms and neonatal units. Parents may also be intimidated by the atmosphere of intensive care and by the behavior of committed staff. Prenatal advance directives allow parents to receive information on outcomes, treatments, and options, including palliative care, 'on their own turf' and as a part of routine prenatal counseling. The use of directives and other techniques for transparency in obstetric and neonatal care could improve the process of informed parental choice.
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Fricke O, Witzel C, Schickendantz S, Sreeram N, Brockmeier K, Schoenau E. Mechanographic characteristics of adolescents and young adults with congenital heart disease. Eur J Pediatr 2008; 167:331-6. [PMID: 17516086 DOI: 10.1007/s00431-007-0495-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Accepted: 04/11/2007] [Indexed: 10/23/2022]
Abstract
The present study comprised 29 adolescents and young adults (15 females, 14 males; aged 14.1-23.9 years) with congenital heart disease (CHD) and focused on the interaction between the biomechanical system and CHD. Individuals were characterized by auxological (height, weight), dynamometric (MIGF, maximal isometric grip force) and mechanograpic parameters (Vmax, maximal velocity; PJF, peak jump force; PJP, peak jump power; time of five stand-ups in chair-rising test). PJF, PJP and MIGF were transformed into height-related SD-scores. MIGF-SDS and PJP-SDS were lower in the CHD patients than in reference individuals. PJP-SDS was lower than PJF-SDS. PJP-SDS was correlated to Vmax (r = 0.62) and to the time of five-stand-ups in chair-rising (r = -0.62). Transcutaneous oxygen saturation and NYHA classes were correlated to Vmax (r = 0.42 and r = -0.57, respectively) and to chair-rising performance (r = -0.60 and r = 0.50, respectively). To conclude, individuals with CHD are characterized by an impaired inter- and intramuscular coordination, which is characterized by a greater decrease in muscular power than muscle force.
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Affiliation(s)
- Oliver Fricke
- Children's Hospital, University of Cologne, Kerpenerstr. 62, D-50924 Cologne, Germany.
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Giannone PJ, Luce WA, Nankervis CA, Hoffman TM, Wold LE. Necrotizing enterocolitis in neonates with congenital heart disease. Life Sci 2008; 82:341-7. [DOI: 10.1016/j.lfs.2007.09.036] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 09/22/2007] [Accepted: 09/22/2007] [Indexed: 10/22/2022]
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Botto LD, Lin AE, Riehle-Colarusso T, Malik S, Correa A. Seeking causes: Classifying and evaluating congenital heart defects in etiologic studies. ACTA ACUST UNITED AC 2007; 79:714-27. [PMID: 17729292 DOI: 10.1002/bdra.20403] [Citation(s) in RCA: 339] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Classification and analysis of congenital heart defects (CHD) in etiologic studies is particularly challenging because of diversity of cardiac phenotypes and underlying developmental mechanisms. We describe an approach to classification for risk assessment of CHD based on developmental and epidemiologic considerations, and apply it to data from the National Birth Defect Prevention Study (NBDPS). METHODS The classification system incorporated the three dimensions of cardiac phenotype, cardiac complexity, and extracardiac anomalies. The system was designed to facilitate the assessment of simple isolated defects and common associations. A team with cardiologic expertise applied the system to a large sample from the NBDPS. RESULTS Of the 4,703 cases of CHDs in the NBDPS with birth years 1997 through 2002, 63.6% were simple, isolated cases. Specific associations of CHDs represented the majority of the remainder. The mapping strategy generated relatively large samples for most cardiac phenotypes and provided enough detail to isolate important subgroups of CHDs that may differ by etiology or mechanism. CONCLUSIONS Classification of CHDs that considers cardiac and extracardiac phenotypes is practically feasible, and yields manageable groups of well-characterized phenotypes. Although best suited for large studies, this approach to classification and analysis can be a flexible and powerful tool in many types of etiologic studies of heart defects.
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Affiliation(s)
- Lorenzo D Botto
- Division of Medical Genetics, University of Utah, Salt Lake City, Utah 84132, USA.
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