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Wang H, Xiao F, Qian Y, Wu B, Dong X, Lu Y, Cheng G, Wang L, Yan K, Yang L, Chen L, Kang W, Li L, Pan X, Wei Q, Zhuang D, Chen D, Yin Z, Yang L, Ni Q, Liu R, Li G, Zhang P, Li X, Peng X, Wang Y, Chen H, Ma X, Liu F, Cao Y, Huang G, Zhou W. Genetic architecture in neonatal intensive care unit patients with congenital heart defects: a retrospective study from the China Neonatal Genomes Project. J Med Genet 2023; 60:247-253. [PMID: 35595280 DOI: 10.1136/jmedgenet-2021-108354] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 05/02/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Congenital heart defects (CHDs) are the most common type of birth defects. The genetic aetiology of CHD is complex and incompletely understood. The overall distribution of genetic causes in patients with CHD from neonatal intensive care units (NICUs) needs to be studied. METHODS CHD cases were extracted from the China Neonatal Genomes Project (2016-2021). Next-generation sequencing results and medical records were retrospectively evaluated to note the frequency of genetic diagnosis and the respective patient outcomes. RESULTS In total, 1795 patients were included. The human phenotype ontology term of atrial septal defect, patent ductus arteriosus and ventricular septal defect account for a large portion of the CHD subtype. Co-occurring extracardiac anomalies were observed in 35.1% of patients. 269 of the cases received genetic diagnoses that could explain the phenotype of CHDs, including 172 copy number variations and 97 pathogenic variants. The detection rate of trio-whole-exome sequencing was higher than clinical exome sequencing (21.8% vs 14.5%, p<0.05). Further follow-up analysis showed the genetic diagnostic rate was higher in the deceased group than in the surviving group (29.0% vs 11.9%, p<0.05). CONCLUSION This is the largest cohort study to explore the genetic spectrum of patients with CHD in the NICU in China. Our findings may benefit future work on improving genetic screening and counselling for NICU patients with CHD.
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Affiliation(s)
- Huijun Wang
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Feifan Xiao
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.,Division of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yanyan Qian
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Bingbing Wu
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xinran Dong
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yulan Lu
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Guoqiang Cheng
- Division of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Laishuan Wang
- Division of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Kai Yan
- Division of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Lin Yang
- Department of Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Liping Chen
- Department of Neonatology, Jiangxi Provincial Children's Hospital, Nanchang, Jiangxi, China
| | - Wenqing Kang
- Department of Neonatology, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
| | - Long Li
- Department of Neonatology, The People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China
| | - Xinnian Pan
- Department of Neonatology, Maternal and Child Health Care Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Qiufen Wei
- Department of Neonatology, Maternal and Child Health Care Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Deyi Zhuang
- Department of Pediatrics, Xiamen Children's Hospital, Xiamen, Fujian, China
| | - Dongmei Chen
- Department of Neonatal Intensive Care Unit, Quanzhou Women's and Children's Hospital, Quanzhou, Fujian, China
| | - Zhaoqing Yin
- Department of Neonatology, The People's Hospital of Dehong, Dehong, Yunnan, China
| | - Ling Yang
- Department of Neonatology, Hainan Women and Children's Medical Center, Haikou, Hainan, China
| | - Qi Ni
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Renchao Liu
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Gang Li
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Ping Zhang
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xu Li
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xiaomin Peng
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yao Wang
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Huiyao Chen
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xiaojing Ma
- Cardiovascular Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Fang Liu
- Cardiovascular Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yun Cao
- Division of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Guoying Huang
- Cardiovascular Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China .,Shanghai Key Laboratory of Birth Defects, Shanghai, China
| | - Wenhao Zhou
- Center for Molecular Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China .,Division of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.,Shanghai Key Laboratory of Birth Defects, Shanghai, China
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Wu Y, Bayrak CS, Dong B, He S, Stenson PD, Cooper DN, Itan Y, Chen L. Identifying shared genetic factors underlying epilepsy and congenital heart disease in Europeans. Hum Genet 2023; 142:275-288. [PMID: 36352240 DOI: 10.1007/s00439-022-02502-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022]
Abstract
Epilepsy (EP) and congenital heart disease (CHD) are two apparently unrelated diseases that nevertheless display substantial mutual comorbidity. Thus, while congenital heart defects are associated with an elevated risk of developing epilepsy, the incidence of epilepsy in CHD patients correlates with CHD severity. Although genetic determinants have been postulated to underlie the comorbidity of EP and CHD, the precise genetic etiology is unknown. We performed variant and gene association analyses on EP and CHD patients separately, using whole exomes of genetically identified Europeans from the UK Biobank and Mount Sinai BioMe Biobank. We prioritized biologically plausible candidate genes and investigated the enriched pathways and other identified comorbidities by biological proximity calculation, pathway analyses, and gene-level phenome-wide association studies. Our variant- and gene-level results point to the Voltage-Gated Calcium Channels (VGCC) pathway as being a unifying framework for EP and CHD comorbidity. Additionally, pathway-level analyses indicated that the functions of disease-associated genes partially overlap between the two disease entities. Finally, phenome-wide association analyses of prioritized candidate genes revealed that cerebral blood flow and ulcerative colitis constitute the two main traits associated with both EP and CHD.
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Affiliation(s)
- Yiming Wu
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Cigdem Sevim Bayrak
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bosi Dong
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Shixu He
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Peter D Stenson
- Institute of Medical Genetics, Cardiff University, Cardiff, UK
| | - David N Cooper
- Institute of Medical Genetics, Cardiff University, Cardiff, UK
| | - Yuval Itan
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Icahn School of Medicine at Mount Sinai, The Charles Bronfman Institute for Personalized Medicine, New York, NY, USA.
| | - Lei Chen
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China.
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Abstract
BACKGROUND Lung function and cardiac function are naturally correlated by sharing the thoracic cage and handling the whole cardiac output sequentially. However, lung function studies are rare in patients with CHD, although results worthy of investigation could be expected. This review summarises existing studies with the lung function parameters (spirometry and body plethysmography) in CHD patients during the last decade. METHODS A systematic review was performed in the relevant database (PubMed, Cochrane, and Scopus) in studies including paediatric and adult patients with CHD where lung parameters (spirometry, body plethysmography) were investigated from January 2010 to December 2020. Two independent reviewers evaluated the studies according to the Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the National Heart, Lung, and Blood Institute. RESULTS Eight studies investigated patients with Fontan palliation including 704 patients (306 female). Four studies included patients after repaired tetralogy of Fallot examining 219 patients (103 female), with one study using double. Further six studies included 3208 (1324 female) children and adults with various CHDs. Overall, four studies were categorised as "good", ten as "fair", and four as "poor". While the measurements were consistently standardised, references to calculate %predicted differed substantially across all studies. All evaluated studies showed reduced forced vital capacity in the majority of CHD patients. CONCLUSIONS Many CHD patients have a reduced forced vital capacity independent of their underlying defect. Spirometry should not only follow a standardised measure according to ATS (update 2019) but also stick to the 2012 GLI reference values.
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Nasr VG, Markham LW, Clay M, DiNardo JA, Faraoni D, Gottlieb-Sen D, Miller-Hance WC, Pike NA, Rotman C. Perioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes 2023; 16:e000113. [PMID: 36519439 DOI: 10.1161/hcq.0000000000000113] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Continuous advances in pediatric cardiology, surgery, and critical care have significantly improved survival rates for children and adults with congenital heart disease. Paradoxically, the resulting increase in longevity has expanded the prevalence of both repaired and unrepaired congenital heart disease and has escalated the need for diagnostic and interventional procedures. Because of this expansion in prevalence, anesthesiologists, pediatricians, and other health care professionals increasingly encounter patients with congenital heart disease or other pediatric cardiac diseases who are presenting for surgical treatment of unrelated, noncardiac disease. Patients with congenital heart disease are at high risk for mortality, complications, and reoperation after noncardiac procedures. Rigorous study of risk factors and outcomes has identified subsets of patients with minor, major, and severe congenital heart disease who may have higher-than-baseline risk when undergoing noncardiac procedures, and this has led to the development of risk prediction scores specific to this population. This scientific statement reviews contemporary data on risk from noncardiac procedures, focusing on pediatric patients with congenital heart disease and describing current knowledge on the subject. This scientific statement also addresses preoperative evaluation and testing, perioperative considerations, and postoperative care in this unique patient population and highlights relevant aspects of the pathophysiology of selected conditions that can influence perioperative care and patient management.
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Amin K, Patel K. Role of Psychologists in Pediatric Congenital Heart Disease. Pediatr Clin North Am 2022; 69:865-878. [PMID: 36207098 DOI: 10.1016/j.pcl.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Congenital heart disease (CHD) is stressful to both pediatric patients and their caregivers. Maternal anxiety during pregnancy is associated with adverse perinatal outcomes. After birth, a prolonged hospital stay can be taxing on the infant and caregiver leading to long-term adverse effects. During adolescence, CHD continues to serve as a stressor for the child not only due to medical care but also due to social limitations and bullying. Many patients also struggle during the transition from adolescence to adult care. Psychologists may aid both the parents and child at all stages from pregnancy to the child's transition to adulthood.
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Affiliation(s)
- Kanhai Amin
- Yale University, 261 Park St, New Haven, CT 06511, USA
| | - Keshav Patel
- Department of Internal Medicine, University of Illinois at Chicago College of Medicine, University of Illinois at Chicago, 840 South Wood Street, Room 440, MC 718, Chicago, IL 60612-7323, USA.
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Abstract
OBJECTIVE Children with CHD may be at increased risk for epilepsy. While the incidence of perioperative seizures after surgical repair of CHD has been well-described, the incidence of epilepsy is less well-defined. We aim to determine the incidence and predictors of epilepsy in patients with CHD. METHODS Retrospective cohort study of patients with CHD who underwent cardiopulmonary bypass at <2 years of age between January, 2012 and December, 2013 and had at least 2 years of follow-up. Clinical variables were extracted from a cardiac surgery database and hospital records. Seizures were defined as acute if they occurred within 7 days after an inciting event. Epilepsy was defined based on the International League Against Epilepsy criteria. RESULTS Two-hundred and twenty-one patients were identified, 157 of whom were included in our analysis. Five patients (3.2%) developed epilepsy. Acute seizures occurred in 12 (7.7%) patients, only one of whom developed epilepsy. Predictors of epilepsy included an earlier gestational age, a lower birth weight, a greater number of cardiac surgeries, a need for extracorporeal membrane oxygenation or a left ventricular assist device, arterial ischaemic stroke, and a longer hospital length of stay. CONCLUSIONS Epilepsy in children with CHD is rare. The mechanism of epileptogenesis in these patients may be the result of a complex interaction of patient-specific factors, some of which may be present even before surgery. Larger long-term follow-up studies are needed to identify risk factors associated with epilepsy in these patients.
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Valencia E, Staffa SJ, Faraoni D, Berry JG, DiNardo JA, Nasr VG. The Role of Chronic Conditions in Outcomes following Noncardiac Surgery in Children with Congenital Heart Disease. J Pediatr 2022; 244:49-57.e8. [PMID: 35074311 DOI: 10.1016/j.jpeds.2022.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To compare outcomes in children with congenital heart disease (CHD) undergoing noncardiac surgery by presence of chronic conditions and identify associated risk factors. STUDY DESIGN Retrospective analysis of 14 031 children with CHD who underwent noncardiac surgery in the 2016 Healthcare Cost and Utilization Project Kid's Inpatient Database. Multivariable regression was used to assess patient and hospital factors associated with in-hospital mortality and length of stay (LOS). RESULTS Overall, 94% had at least 1 chronic condition. The in-hospital mortality rate was 5.6%. Neonates with CHD only had the highest mortality (15.6%); otherwise, children with CHD and at least 1 chronic condition had higher mortality than patients with CHD only (infant 3.93%, child 1.22%, adolescent 1.04% vs 2.34%, 0%, and 0%). Neonates (OR, 15.5; 95% CI, 7.1-34.1 vs adolescent), number of chronic conditions (OR, 1.34; 95% CI, 1.27-1.42), chronic conditions type (circulatory system; OR 2.46; 95% CI, 2.04-2.98), and low socioeconomic status (OR, 1.36; 95% CI, 1.05-1.77) were associated with increased mortality. The median LOS was 20 days (IQR, 5-66). Those with CHD and at least 1 chronic condition had a greater LOS (21 days; IQR, 5-68) than those with CHD only (9 days; IQR, 3-46). Neonates (adjusted coefficient, 44.3; 95% CI, 40.3-48.3 vs adolescent), Black race (adjusted coefficient, 4.78; 95% CI, 2.27-7.3), chronic condition indicator number (adjusted coefficient, 5.17; 95% CI, 4.56-5.78), and subtype (adjusted coefficient, 23.6; 95% CI, 20.4-26.7) were associated with a prolonged LOS. CONCLUSIONS Most children with CHD who undergo noncardiac surgery have at least 1 chronic condition. Age, chronic conditions type and number, low socioeconomic status, and Black race impart increased risks of in-hospital mortality and prolonged LOS. Further research is needed to evaluate the impact of specific chronic conditions and determine barriers to equitable care.
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Affiliation(s)
- Eleonore Valencia
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - David Faraoni
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Jay G Berry
- Complex Care, Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - James A DiNardo
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Viviane G Nasr
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
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Variables Prevalent Among Early Unplanned Readmissions in Infants Following Congenital Heart Surgery. Pediatr Cardiol 2021; 42:1449-1456. [PMID: 33974090 DOI: 10.1007/s00246-021-02631-z] [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: 03/01/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
Medically complex children including infants undergoing cardiac surgery are at increased risk for hospital readmissions. Investigation of this population may reveal opportunities to optimize systems and coordination of care. A retrospective study of all infants undergoing cardiac surgery from 2015 through 2016 at a large tertiary institution who were readmitted within 1 year of discharge from cardiac surgical hospitalization was performed. Data specific to patient characteristics, surgical hospitalization, and readmission hospitalization are described. Unplanned readmissions within 1 year of hospital discharge were analyzed with Cox proportional hazard regression to identify factors associated with increased hazard for earlier unplanned readmission. Comparable to previous reports, 12% (78/658) of all surgical hospitalizations were associated with unplanned readmission within 30 days. Infectious etiology, followed by cardiac and gastrointestinal problems, was the most common reasons for unplanned 30-day readmission. Unplanned readmissions within 2 weeks of discharge were multifactorial and less commonly related to cardiac or surgical care. Primary nasogastric tube feeding at the time of discharge was the only significant risk factor for earlier unplanned readmission (p = 0.032) on multivariable analysis. Increased care coordination with particular attention to feeding and comorbidity management may be future targets to effectively mitigate readmissions and improve quality of care in this population.
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Faim D, Tiago J, Castelo R, Francisco A, Alves R, Pires A. Congenital Heart Disesase: A Retrospective Analysis from a Tertiary Referral Centre in Portugal. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20200238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Gonzalez VJ, Kimbro RT, Cutitta KE, Shabosky JC, Bilal MF, Penny DJ, Lopez KN. Mental Health Disorders in Children With Congenital Heart Disease. Pediatrics 2021; 147:peds.2020-1693. [PMID: 33397689 PMCID: PMC7849200 DOI: 10.1542/peds.2020-1693] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Data on anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD) are lacking for youth with congenital heart disease (CHD), particularly those with simple CHD. This study aims to characterize these disorders in youth with CHD compared to those without CHD. METHODS A comparative cross-sectional study was conducted by using the electronic medical records of a large tertiary care hospital between 2011 and 2016. Inclusion criteria were youth aged 4 to 17 years with >1 hospitalization or emergency department visits. Exclusion criteria were patients with arrhythmias or treatment with clonidine and/or benzodiazepines. The primary predictor variable was CHD type: simple, complex nonsingle ventricle, and complex single ventricle. The primary outcome variable was a diagnosis and/or medication for anxiety and/or depression or ADHD. Data were analyzed by using logistic regression (Stata v15; Stata Corp, College Station, TX). RESULTS We identified 118 785 patients, 1164 with CHD. Overall, 18.2% (n = 212) of patients with CHD had a diagnosis or medication for anxiety or depression, compared with 5.2% (n = 6088) of those without CHD. All youth with CHD had significantly higher odds of anxiety and/or depression or ADHD. Children aged 4 to 9 years with simple CHD had ∼5 times higher odds (odds ratio: 5.23; 95% confidence interval: 3.87-7.07) and those with complex single ventricle CHD had ∼7 times higher odds (odds ratio: 7.46; 95% confidence interval: 3.70-15.07) of diagnosis or treatment for anxiety and/or depression. Minority and uninsured youth were significantly less likely to be diagnosed or treated for anxiety and/or depression or ADHD, regardless of disease severity. CONCLUSIONS Youth with CHD of all severities have significantly higher odds of anxiety and/or depression and ADHD compared to those without CHD. Screening for these conditions should be considered in all patients with CHD.
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Affiliation(s)
- Vincent J. Gonzalez
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas; and
| | | | - Katherine E. Cutitta
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas; and
| | - John C. Shabosky
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas; and
| | - Mohammad F. Bilal
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas; and
| | - Daniel J. Penny
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas; and
| | - Keila N. Lopez
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas; and
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Thomford NE, Biney RP, Okai E, Anyanful A, Nsiah P, Frimpong PG, Boakye DO, Adongo CA, Kruszka P, Wonkam A. Clinical Spectrum of congenital heart defects (CHD) detected at the child health Clinic in a Tertiary Health Facility in Ghana: a retrospective analysis. JOURNAL OF CONGENITAL CARDIOLOGY 2020. [DOI: 10.1186/s40949-020-00034-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Congenital heart defects (CHD) are the singular most common congenital anomalies and account for a significant fraction of childhood mortality and morbidity. CHD occurs in ~ 1% of livebirths globally and often requires surgical interventions to improve quality of life and survival of patients. The prevalence and clinical presentations of CHD within specific populations provide a clearer overview of the burden of CHD and informs appropriate interventions. However, there is limited data on clinical presentation and occurrence of CHD in African countries such as Ghana where most cases are either diagnosed late or missed entirely resulting in increased mortality. In this retrospective study, we assessed the clinical presentations, associated comorbidities, and prescription patterns of diagnosed CHD in a tertiary facility in Ghana.
Method
This retrospective study utilized data from electronic health records (EHR) from the child health clinic of the Cape Coast Teaching Hospital - a tertiary health facility in Ghana from January 2018 to October 2019. All suspected or provisionally diagnosed cases including those confirmed with echocardiography were included in our analysis.
Results
Over 10, 000 records were reviewed, CHD was diagnosed in 79 cases, and 51 cases had complete clinical records including the type of CHD and clinical presentation. Male to female ratio was approximately 1:1 and 77.2% of the diagnoses were in children below 5 years. Acyanotic congenital heart defects were most commonly diagnosed with ventricular septal defects (VSD) and patent ductus arteriosus (PDA) being the simplest singular CHD. Tetralogy of Fallot, was the most common complex CHD accounting for 25.5% (13) of cases. Bronchopneumonia, upper respiratory infections and pneumonia were the most commonly diagnosed comorbidities accounting for over 35% of non-cardiac sequalae based on antibiotic and diuretic use.
Conclusion
Our study showed that over 75% of CHD cases were diagnosed under 5 years with VSD and TOF being the most commonly diagnosed acyanotic and cyanotic lesions, respectively. This study presents preliminary data that give an overview of CHD burden in Ghana that will inform future research and appropriate interventions.
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Combs D, Edgin JO, Klewer S, Barber BJ, Morgan WJ, Hsu CH, Abraham I, Parthasarathy S. OSA and Neurocognitive Impairment in Children With Congenital Heart Disease. Chest 2020; 158:1208-1217. [PMID: 32222588 DOI: 10.1016/j.chest.2020.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 02/03/2020] [Accepted: 03/11/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Children with congenital heart disease (CHD) have an increased risk of neurocognitive impairment. No prior studies have evaluated the role of OSA, which is associated with neurocognitive impairment in children without CHD. RESEARCH QUESTION Is OSA is associated with neurocognitive impairment in children with CHD? STUDY DESIGN AND METHODS Children aged 6 to 17 years with corrected moderate to complex CHD without syndromes that may affect neurocognition were recruited from the pediatric cardiology clinic. Participants underwent home sleep testing and neurocognitive testing, including a validated Intellectual Quotient (IQ) test as well as validated tests of memory (Paired Associates Learning test), executive function (Intra-Extra Dimensional set shift test), and attention (Simple Reaction Test) from the CANTAB neurocognitive testing battery. RESULTS Complete results were available for 30 children. Seventeen children (57%) were found to have OSA. Total IQ was markedly lower in children with CHD and comorbid OSA compared with children with CHD without comorbid OSA (mean, 86 ± 12 vs 98 ± 11; P = .01). Children with CHD and OSA did significantly worse on the Paired Associates Learning test, with a median of eight total errors (interquartile range [IQR], 2.25-15) compared with children with CHD without OSA (median total errors, 2, IQR, 1-8; P = .02). INTERPRETATION Children with CHD and comorbid OSA have impaired neurocognition compared with children with CHD without comorbid OSA. OSA may be a reversible cause of neurocognitive impairment in children with CHD. Further research is needed to evaluate the effects of OSA treatment on neurocognitive impairment in children with CHD.
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Affiliation(s)
- Daniel Combs
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Arizona, Tucson, AZ; Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, AZ; University of Arizona Health Sciences Center for Sleep & Circadian Science, University of Arizona, Tucson, AZ.
| | - Jamie O Edgin
- Department of Psychology, University of Arizona, Tucson, AZ
| | - Scott Klewer
- Department of Pediatrics, Division of Cardiology, University of Arizona, Tucson, AZ
| | - Brent J Barber
- Department of Pediatrics, Division of Cardiology, University of Arizona, Tucson, AZ
| | - Wayne J Morgan
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Arizona, Tucson, AZ
| | - Chiu-Hsieh Hsu
- Department of Epidemiology & Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Ivo Abraham
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ
| | - Sairam Parthasarathy
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, AZ; University of Arizona Health Sciences Center for Sleep & Circadian Science, University of Arizona, Tucson, AZ
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Monteiro SA, Serrano F, Tsang R, Smith Hollier E, Guffey D, Noll L, Voigt RG, Ghanayem N, Shekerdemian L. Ancillary referral patterns in infants after initial assessment in a cardiac developmental outcomes clinic. CONGENIT HEART DIS 2019; 14:797-802. [DOI: 10.1111/chd.12789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/04/2019] [Accepted: 04/21/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Faridis Serrano
- Department of Pediatrics Baylor College of Medicine Houston Texas
| | - Rocky Tsang
- Department of Pediatrics Baylor College of Medicine Houston Texas
| | | | - Danielle Guffey
- Dan L Duncan Institute for Clinical and Translational Research Baylor College of Medicine Houston Texas
| | - Lisa Noll
- Department of Pediatrics Baylor College of Medicine Houston Texas
| | - Robert G. Voigt
- Department of Pediatrics Baylor College of Medicine Houston Texas
| | - Nancy Ghanayem
- Department of Pediatrics Baylor College of Medicine Houston Texas
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Zhao QM, Liu F, Wu L, Ma XJ, Niu C, Huang GY. Prevalence of Congenital Heart Disease at Live Birth in China. J Pediatr 2019; 204:53-58. [PMID: 30270157 DOI: 10.1016/j.jpeds.2018.08.040] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/26/2018] [Accepted: 08/17/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate the prevalence of congenital heart disease (CHD) in China based on a large prospective multicenter screening study. STUDY DESIGN A total of 122 765 consecutive infants born at 18 hospitals throughout China between August 1, 2011, and November 30, 2012, were included. Cases of CHD were identified by echocardiography, clinical assessment, and telephone follow-up. RESULTS The overall prevalence of CHD was 8.98 per 1000 live births (critical, 1.46; serious, 1.47; significant, 5.00; nonsignificant, 1.07), including 7.15 in male infants and 11.11 in female infants. The most common CHD was ventricular septal defect (3.3), followed by atrial septal defect (1.7), patent ductus arteriosus (0.78), pulmonary stenosis (0.73), tetralogy of Fallot (0.47), and transposition of the great arteries (0.35). Female predominance was observed for all CHD and mild CHD (significant and nonsignificant), and male predominance was observed for the critical CHDs. The proportion of preterm newborns was substantially higher among the major CHD cases (critical and serious) compared with normal newborns. There were appreciably more low birth weight infants among the critical CHD cases compared with normal newborns. Significantly higher rates of ventricular septal defect and atrioventricular septal defect were found in infants born to mothers aged ≥35 years. Extracardiac anomalies were found in 9.3% of CHD cases. The risk of CHD was increased by approximately 3-fold when a first-degree relative had CHD. CONCLUSIONS Our estimates are concordant with data from Western studies. This screening study may provide more accurate and complete information on the overall prevalence of CHD in China.
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Affiliation(s)
- Qu-Ming Zhao
- Pediatric Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Fang Liu
- Pediatric Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Lin Wu
- Pediatric Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Xiao-Jing Ma
- Pediatric Heart Center, Children's Hospital of Fudan University, Shanghai, China; Shanghai Key Laboratory of Birth Defects, Shanghai, China
| | - Conway Niu
- Pediatric Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Guo-Ying Huang
- Pediatric Heart Center, Children's Hospital of Fudan University, Shanghai, China; Shanghai Key Laboratory of Birth Defects, Shanghai, China.
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Pfitzer C, Helm PC, Blickle MJ, Rosenthal LM, Berger F, Abdul-Khaliq H, Bauer UMM, Schmitt KRL. Educational achievement of children with congenital heart disease: Promising results from a survey by the German National Register of Congenital Heart Defects. Early Hum Dev 2019; 128:27-34. [PMID: 30448707 DOI: 10.1016/j.earlhumdev.2018.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 05/29/2018] [Accepted: 11/02/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Survival rates of children with congenital heart disease (CHD) have increased significantly in the decade. There is now increased interest in the long-term outcome and quality of life of these children. AIMS To assess the educational achievement of patients with CHD in Germany. STUDY DESIGN Cross-sectional study using an online survey. The recruitment of study participants was carried out via the database of the German National Register for Congenital Heart Defects (NRCHD). SUBJECTS Patients born between 1992 and 2011 were enrolled in the study. For 2609 study participants (female = 1870 (71.7%); 1072 (41.1%) patients; 1537 (58.9%) parents), who participated in the survey, detailed information regarding the underlying CHD diagnosis and clinical data was available. OUTCOME MEASURES Age at enrollment, secondary school form, school year repetition, school degree. RESULTS The large majority of study participants were enrolled at a conventional elementary school (83.4%) and started school at the age of 6 years or below (73.3%). In total 45.7% of graduated study participants graduated with the qualification necessary to study at any university. In terms of analysis of the different CHD severity subgroups 57.3% of patients with a mild CHD, 47.5% with a moderate CHD and only 35.1% suffering from a severe CHD attained a high school diploma. CONCLUSIONS In our study, the majority of participating CHD patients had a standard school career. These initial results are of great importance to affected families and treating physicians as they show that, in general, a normal school career is possible for all CHD patients.
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Affiliation(s)
- Constanze Pfitzer
- Department of Congenital Heart Disease - Paediatric Cardiology, Deutsches Herzzentrum Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany.
| | - Paul C Helm
- National Register for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Maximilian J Blickle
- Department of Congenital Heart Disease - Paediatric Cardiology, Deutsches Herzzentrum Berlin, Germany
| | - Lisa-Maria Rosenthal
- Department of Congenital Heart Disease - Paediatric Cardiology, Deutsches Herzzentrum Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease - Paediatric Cardiology, Deutsches Herzzentrum Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany; Department of Paediatric Cardiology, Charite - Universitaetsmedizin Berlin, Germany
| | - Hashim Abdul-Khaliq
- Department of Paediatric Cardiology, University Hospital Homburg Saar, Germany
| | - Ulrike M M Bauer
- National Register for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany; Competence Network for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Katharina R L Schmitt
- Department of Congenital Heart Disease - Paediatric Cardiology, Deutsches Herzzentrum Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
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17
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Estimating Surgical Risk in Younger and Older Children With Congenital Heart Disease. J Surg Res 2018; 232:298-307. [DOI: 10.1016/j.jss.2018.06.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 06/05/2018] [Accepted: 06/19/2018] [Indexed: 12/18/2022]
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18
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Mebus S, Nagdyman N, Kügel J, Zachoval R, Braun SL, Haverkämper G, Opgen-Rhein B, Berger F, Horster S, Schoetzau J, Salvador CP, Bauer U, Hess J, Ewert P, Kaemmerer H. Non-invasive assessment of liver changes in Eisenmenger patients. Int J Cardiol 2018; 249:140-144. [PMID: 29121718 DOI: 10.1016/j.ijcard.2017.07.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/04/2017] [Accepted: 07/10/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Eisenmenger syndrome as a severe form of cyanotic congenital heart disease results in a complex multisystemic disorder. Due to increased systemic venous pressure and the inability to ensure systemic perfusion and metabolic requirements, the liver may develop congestion, fibrosis or cirrhosis. This study aimed to assess hepatic abnormalities in Eisenmenger patients non-invasively. METHODS AND RESULTS 10 adults with Eisenmenger syndrome (six female; median age 44.2years; range 23-62years) were enrolled and hepatic involvement was assessed - using clinical assessment, laboratory analysis, hepatic fibrotic markers, abdominal sonography and liver stiffness measurements (transient elastography (TE) and acoustic radiation force impulse imaging (ARFI)). Using imaging and laboratory analysis, 60% (6/10) of the Eisenmenger patients had signs of liver fibrosis (5/10) or cirrhosis (1/10). While TE, however, showed no relevant liver abnormalities in any Eisenmenger patient, ARFI detected liver fibrosis in 5/10 and cirrhosis and 1/10 patients. CONCLUSIONS Adult Eisenmenger patients are at increased risk of hepatic impairment. Non-invasive screening could be helpful in detecting liver alterations. In our small series, however, TE could not detect fibrosis or cirrhosis in any affected patient, while ARFI was very reliable. Patients should be transferred to centres, where a multidisciplinary expert knowledge is available and a close collaboration between cardiologists and hepatologists exists.
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Affiliation(s)
- Siegrun Mebus
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Nicole Nagdyman
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Johanna Kügel
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Reinhart Zachoval
- Department of Gastroenterology and Hepatology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Siegmund Lorenz Braun
- Institute of Laboratory Medicine, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Guido Haverkämper
- Department of Congenital Heart Defects and Pediatric Cardiology, German Heart Centre Berlin and Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Opgen-Rhein
- Department of Congenital Heart Defects and Pediatric Cardiology, German Heart Centre Berlin and Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Defects and Pediatric Cardiology, German Heart Centre Berlin and Charité Universitätsmedizin Berlin, Berlin, Germany; DZHK (German Cardiovascular Research Centre), partner site Berlin, Berlin, Germany
| | - Sophia Horster
- Department of Gastroenterology and Hepatology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jörg Schoetzau
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Claudia Pujol Salvador
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Ulrike Bauer
- Competence Network for Congenital Heart Defects, Berlin, Germany
| | - John Hess
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Harald Kaemmerer
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany.
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Kaito T, Shimada M, Ichikawa H, Makino T, Takenaka S, Sakai Y, Yoshikawa H, Hoashi T. Prevalence of and Predictive Factors for Scoliosis After Surgery for Congenital Heart Disease in the First Year of Life. JB JS Open Access 2018; 3:e0045. [PMID: 30229236 PMCID: PMC6132905 DOI: 10.2106/jbjs.oa.17.00045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The surgical treatment of congenital heart disease is reported to be associated with a high prevalence of scoliosis, although the detailed etiology is unknown. Surgical interventions involving the rib cage are considered to increase the risk of scoliosis. However, whether the cardiac condition or the procedure performed makes patients more susceptible to the development of spinal deformity is controversial. Methods The present study included 483 patients who underwent surgery for the treatment of congenital heart disease with use of procedures involving the immature rib cage (sternotomy and/or thoracotomy) during the first year of life, followed by the evaluation of standing chest radiographs at ≥10 years of age. Patients with congenital spinal deformity and potential neuromuscular disease were excluded. The prevalence of and predictive factors for scoliosis were evaluated. The presence of scoliosis (Cobb angle ≥10° to <20°, ≥20° to <30°, ≥30° to <45°, ≥45°), the convex side of the curve, and the location of the curve were evaluated radiographically. Potential predictive factors that were analyzed included the age at the time of surgery, surgical approach, use of cardiopulmonary bypass, postoperative heart failure and/or cyanosis, New York Heart Association (NYHA) class, cardiomegaly, and age at the time of radiography. Results The mean age at the time of surgery was 112 days, and the mean age at the time of radiography was 14.4 years. The prevalence of scoliosis was 42.4%, and the prevalences of ≥10° to <20°, ≥20° to <30°, ≥30° to <45°, and ≥45° scoliosis were 31.7%, 5.8%, 2.5%, and 2.5%, respectively. Three patients underwent surgery for the treatment of progressive scoliosis. Multivariate analysis indicated that the predictive factors were female sex, left thoracotomy, bilateral thoracotomy, NYHA class, and age at the time of radiography for ≥10° scoliosis; cardiomegaly, NYHA class, and age at the time of radiography for ≥20° scoliosis; cardiomegaly, number of surgical procedures, and age at the time of radiography for ≥30° scoliosis; and cardiomegaly for ≥45° scoliosis. Age at the time of radiography was a predictor of <45° scoliosis; however, the relative association was small. Conclusions Surgery for the treatment of congenital heart disease during the first year of life was associated with a high prevalence of scoliosis (≥40%). While female sex was one of several predictors of ≥10° scoliosis, cardiomegaly was the sole predictor of ≥45° scoliosis. Level of Evidence Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Takashi Kaito
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masatoshi Shimada
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takahiro Makino
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shota Takenaka
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yusuke Sakai
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hideki Yoshikawa
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takaya Hoashi
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan
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21
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Lu JC, Lowery R, Yu S, Ghadimi Mahani M, Agarwal PP, Dorfman AL. Predictors of missed appointments in patients referred for congenital or pediatric cardiac magnetic resonance. Pediatr Radiol 2017; 47:911-916. [PMID: 28432402 DOI: 10.1007/s00247-017-3851-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/19/2017] [Accepted: 03/27/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Congenital cardiac magnetic resonance is a limited resource because of scanner and physician availability. Missed appointments decrease scheduling efficiency, have financial implications and represent missed care opportunities. OBJECTIVE To characterize the rate of missed appointments and identify modifiable predictors. MATERIALS AND METHODS This single-center retrospective study included all patients with outpatient congenital or pediatric cardiac MR appointments from Jan. 1, 2014, through Dec. 31, 2015. We identified missed appointments (no-shows or same-day cancellations) from the electronic medical record. We obtained demographic and clinical factors from the medical record and assessed socioeconomic factors by U.S. Census block data by patient ZIP code. Statistically significant variables (P<0.05) were included into a multivariable analysis. RESULTS Of 795 outpatients (median age 18.5 years, interquartile range 13.4-27.1 years) referred for congenital cardiac MR, a total of 91 patients (11.4%) missed appointments; 28 (3.5%) missed multiple appointments. Reason for missed appointment could be identified in only 38 patients (42%), but of these, 28 (74%) were preventable or could have been identified prior to the appointment. In multivariable analysis, independent predictors of missed appointments were referral by a non-cardiologist (adjusted odds ratio [AOR] 5.8, P=0.0002), referral for research (AOR 3.6, P=0.01), having public insurance (AOR 2.1, P=0.004), and having scheduled cardiac MR from November to April (AOR 1.8, P=0.01). CONCLUSION Demographic factors can identify patients at higher risk for missing appointments. These data may inform initiatives to limit missed appointments, such as targeted education of referring providers and patients. Further data are needed to evaluate the efficacy of potential interventions.
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Affiliation(s)
- Jimmy C Lu
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan Health System, University of Michigan Congenital Heart Center, C. S. Mott Children's Hospital, 1540 E. Hospital Drive, Ann Arbor, MI, 48109-4204, USA.
- Department of Radiology, University of Michigan Health System, Section of Pediatric Radiology, C. S. Mott Children's Hospital, Ann Arbor, MI, USA.
| | - Ray Lowery
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan Health System, University of Michigan Congenital Heart Center, C. S. Mott Children's Hospital, 1540 E. Hospital Drive, Ann Arbor, MI, 48109-4204, USA
| | - Sunkyung Yu
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan Health System, University of Michigan Congenital Heart Center, C. S. Mott Children's Hospital, 1540 E. Hospital Drive, Ann Arbor, MI, 48109-4204, USA
| | - Maryam Ghadimi Mahani
- Department of Radiology, University of Michigan Health System, Section of Pediatric Radiology, C. S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Prachi P Agarwal
- Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Adam L Dorfman
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan Health System, University of Michigan Congenital Heart Center, C. S. Mott Children's Hospital, 1540 E. Hospital Drive, Ann Arbor, MI, 48109-4204, USA
- Department of Radiology, University of Michigan Health System, Section of Pediatric Radiology, C. S. Mott Children's Hospital, Ann Arbor, MI, USA
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Resource Utilization Associated with Extracardiac Co-morbid Conditions Following Congenital Heart Surgery in Infancy. Pediatr Cardiol 2017; 38:1065-1070. [PMID: 28456828 DOI: 10.1007/s00246-017-1620-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
Abstract
Congenital heart disease (CHD) is often associated with chronic extracardiac co-morbid conditions (ECC). The presence of ECC has been associated with greater resource utilization during the operative period; however, the impact beyond hospital discharge has not been described. This study sought to understand the scope of chronic ECC in infants with CHD as well as to describe the impact of ECC on resource utilization after discharge from the index cardiac procedure. IRB approved this retrospective study of infants <1 year who had cardiac surgery from 2006 and 2011. Demographics, diagnoses, procedures, STAT score, and ECC were extracted from the medical record. Administrative data provided frequency of clinic and emergency room visits, admissions, cumulative hospital days, and hospital charges for 2 years after discharge from the index procedure. Data were compared using Mann-Whitney Rank Sum Test with p < 0.05 considered significant. ECC occurred in 55% (481/876) of infants. Median STAT score was higher in the group with ECC (3 vs. 2, p < 0.001). Resource utilization after discharge from the index procedure as defined by median hospital charges (78 vs. 10 K, p < 0.001 and unplanned hospital days 4 vs. 0, p < 0.001) was higher in those with ECC, and increased with the greater number of ECC, even after accounting for surgical complexity. STAT score and the presence of multiple ECC were associated with higher resource utilization following the index cardiac surgical procedure. These data may be helpful in deciding which children might benefit from a cardiac complex care program that partners families and providers to improve health and decrease healthcare costs.
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Hallit S, Salameh P. Exposure to toxics during pregnancy and childhood and asthma in children: A pilot study. J Epidemiol Glob Health 2017; 7:147-154. [PMID: 28756822 PMCID: PMC7320455 DOI: 10.1016/j.jegh.2017.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 04/21/2017] [Indexed: 11/24/2022] Open
Abstract
Environmental factors, pesticides, alcohol and smoking are linked to asthma in children. The association of toxic substances exposure with asthma has not been evaluated. Our objective is to assess such associations among children aged less than 16 years old. This is a cross-sectional study, conducted between January and May 2015, using a sample of Lebanese students from private schools in Beirut and Mount Lebanon. Out of 700 distributed questionnaires, 527 (75.2%) were returned to us. Verbal informed consent was also obtained from all parents prior to participating in the study. A significant association was found between waterpipe smoking and diagnosed asthma (p = 0.003; ORa = 13.25; 95% CI 2.472–71.026). Alcohol during pregnancy, waterpipe smoking during pregnancy and parents respiratory problems significantly increased the risk of respiratory problems by approximately 5 times, 6 times and 2 times respectively (p = 0.016; ORa = 4.889; 95% CI 1.339–17.844, p = 0.021; ORa = 6.083; 95% CI 1.314–28.172, p = 0.004; ORa = 1.748; 95% CI 1.197–2.554 respectively). Waterpipe smoking, alcohol during pregnancy, recurrent otitis and humidity at home seem to be significantly correlated with asthma in children. Spreading awareness by health care professionals is needed to permit a reduction of the prevalence of these allergic diseases, especially asthma, in children.
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Affiliation(s)
- Souheil Hallit
- Lebanese University, School of Pharmacy, Hadath, Lebanon; Universite Saint Joseph, Faculty of Pharmacy, Beirut, Lebanon; Universite Saint-Esprit Kaslik, Faculty of Medicine, Kaslik, Lebanon; Psychiatric Hospital of the Cross, P.O. Box 60096, Jal Eddib, Lebanon; Occupational Health Environment Research Team, U1219 BPH Bordeaux Population Health Research Center Inserm - Université de Bordeaux, France.
| | - Pascale Salameh
- Lebanese University, School of Pharmacy, Hadath, Lebanon; Lebanese University, Faculty of Medicine, Hadath, Lebanon
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Pongiglione G, Possidoni A, di Luzio Paparatti U, Costanzo AM, Gualberti G, Bonvicini M, Rimini A, Agnoletti G, Calabrò MP, Pozzi M, Tumbarello R, Salice P, Fiorini P, Russo MG, Milanesi O. Incidence of Respiratory Disease During the First Two Years of Life in Children with Hemodynamically Significant Congenital Heart Disease in Italy: A Retrospective Study. Pediatr Cardiol 2016; 37:1581-1589. [PMID: 27573216 DOI: 10.1007/s00246-016-1473-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 08/16/2016] [Indexed: 11/26/2022]
Abstract
Children affected by hemodynamically significant congenital heart disease (HSCHD) experience severe respiratory complications that can increase the frequency of hospitalizations. The aim of the SINERGY study was to describe the incidence of respiratory diseases and to collect information on active and passive immunoprophylaxis in the first 2 years of life. In this retrospective, multicenter, and epidemiologic study, children with HSCHD were enrolled across 11 Italian sites. Children born between December 31, 2007, and December 31, 2012, were observed during their first 2 years of life. Data were collected through hospital database searches and parent interviews. Four hundred twenty children were enrolled: 51.7 % were female, 79.5 % were born full-term (≥37 weeks), and 77.6 % weighed >2500 g at birth. The most frequent heart defects were ventricular septal defect (23.1 %) and coarctation of the aorta (14.3 %). The incidence of respiratory diseases was 63.1 %. Frequent respiratory diseases not requiring hospitalization were upper respiratory tract infections (76.4 %), acute bronchitis (43.3 %), and influenza (22.1 %), while those requiring hospitalization were bronchitis and bronchiolitis (8.3 % each one). While active immunoprophylaxis was applied with wide compliance (diphtheria/pertussis/tetanus, 99.5 %; Haemophilus influenzae type b, 72.5 %; pneumococcus, 79.9 %; meningococcus, 77.4 %), only 54 % of children received respiratory syncytial virus (RSV) passive prophylaxis (palivizumab). Of the 35 hospitalizations due to bronchiolitis, 27 (77.1 %) did not receive prophylaxis against RSV, compared with 8 (22.9 %) who received prophylaxis (P < 0.0001). Children with HSCHD are at major risk of respiratory diseases. Passive immunoprophylaxis can help to prevent hospitalizations for bronchiolitis.
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Affiliation(s)
- Giacomo Pongiglione
- Centro Cardiologico Paediatrico del Mediterraneo Taormina, Bambino Gesù Roma, Rome, Italy
| | - Alessandro Possidoni
- AbbVie SrL Italy, Campoverde, Via Pontina km 52, Campoverde di Aprilia (LT), Latina, Italy
| | | | - Anna Maria Costanzo
- AbbVie SrL Italy, Campoverde, Via Pontina km 52, Campoverde di Aprilia (LT), Latina, Italy.
| | - Giuliana Gualberti
- AbbVie SrL Italy, Campoverde, Via Pontina km 52, Campoverde di Aprilia (LT), Latina, Italy
| | - Marco Bonvicini
- Azienda Ospedaliero Universitaria di Bologna, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | | | - Gabriella Agnoletti
- A.O. Città della Salute e della Scienza di Torino, Ospedale Infantile Regina Margherita Torino, Turin, Italy
| | - Maria Pia Calabrò
- Azienda Ospedaliera Universitaria Policlinico "G. Martino" di Messina, Messina, Italy
| | - Marco Pozzi
- Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona "Umberto I, G.M. Lancisi, G. Salesi", Ancona, Italy
| | | | - Patrizia Salice
- IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Patrizio Fiorini
- Azienda Ospedaliero-Universitaria Meyer Firenze, Florence, Italy
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Post-Operative Outcomes in Children With and Without Congenital Heart Disease Undergoing Noncardiac Surgery. J Am Coll Cardiol 2016; 67:793-801. [DOI: 10.1016/j.jacc.2015.11.057] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 11/03/2015] [Indexed: 11/22/2022]
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Faraoni D, Nasr VG, DiNardo JA. Overall Hospital Cost Estimates in Children with Congenital Heart Disease: Analysis of the 2012 Kid's Inpatient Database. Pediatr Cardiol 2016; 37:37-43. [PMID: 26184611 DOI: 10.1007/s00246-015-1235-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/09/2015] [Indexed: 11/27/2022]
Abstract
This study sought to determine overall hospital cost in children with congenital heart disease (CHD) and to compare cost associated with cardiac surgical procedures, cardiac catheterizations, non-cardiac surgical procedures, and medical admissions. The 2012 Healthcare Cost and Utilization Project Kid's Inpatient Database was used to evaluate hospital cost in neonates and children with CHD undergoing cardiac surgery, cardiac catheterization, non-cardiac surgical procedures, and medical treatments. Multivariable logistic regression was applied to determine independent predictors for increased hospital cost. In 2012, total hospital cost was 28,900 M$, while hospital cost in children with CHD represented 23% of this total and accounted for only 4.4% of hospital discharges. The median cost was $51,302 ($32,088-$100,058) in children who underwent cardiac surgery, $21,920 ($13,068-$51,609) in children who underwent cardiac catheterization, $4134 ($1771-$10,253) in children who underwent non-cardiac surgery, and $23,062 ($5529-$71,887) in children admitted for medical treatments. Independent predictors for increased cost were hospital bed size <400 beds (P < 0.001), more than four procedures performed during the same hospitalization (P = 0.001), use of ECMO (P < 0.001), length of hospital stay exceeding 14 days (P < 0.001), cardiac failure (P < 0.001), sepsis (P < 0.001), acute kidney injury (P < 0.001), and neurologic (P < 0.001) and thromboembolic complications (P < 0.001). Hospital cost in children with CHD represented 23% of global cost while accounting for only 4.4% of discharges. This study identified factors associated with increased cost of cardiac surgical procedures, cardiac catheterizations, non-cardiac surgical procedures, and medical management in children with CHD.
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Affiliation(s)
- David Faraoni
- Department of Anesthesiology, Peri-operative and Pain Medicine, Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Viviane G Nasr
- Department of Anesthesiology, Peri-operative and Pain Medicine, Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - James A DiNardo
- Department of Anesthesiology, Peri-operative and Pain Medicine, Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
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Lee YS, Jeng MJ, Tsao PC, Soong WJ, Chou P. Prognosis and Risk Factors for Congenital Airway Anomalies in Children with Congenital Heart Disease: A Nationwide Population-Based Study in Taiwan. PLoS One 2015; 10:e0137437. [PMID: 26334302 PMCID: PMC4559478 DOI: 10.1371/journal.pone.0137437] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/26/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The mortality risk associated with congenital airway anomalies (CAA) in children with congenital heart disease (CHD) is unclear. This study aimed to investigate the factors associated with CAA, and the associated mortality risk, among children with CHD. METHODS This nationwide, population-based study evaluated 39,652 children with CHD aged 0-5 years between 2000 and 2011, using the Taiwan National Health Insurance Research Database (NHIRD). We performed descriptive, logistic regression, Kaplan-Meier, and Cox regression analyses of the data. RESULTS Among the children with CHD, 1,591 (4.0%) had concomitant CAA. Children with CHD had an increased likelihood of CAA if they were boys (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.33-1.64), infants (OR, 5.42; 95%CI, 4.06-7.24), or had a congenital musculoskeletal anomaly (OR, 3.19; 95%CI, 2.67-3.81), and were typically identified 0-3 years after CHD diagnosis (OR, 1.33; 95%CI 1.17-1.51). The mortality risk was increased in children with CHD and CAA (crude hazard ratio [HR], 2.05; 95%CI, 1.77-2.37), even after adjusting for confounders (adjusted HR, 1.76; 95%CI, 1.51-2.04). Mortality risk also changed by age and sex (adjusted HR and 95%CI are quoted): neonates, infants, and toddlers and preschool children, 1.67 (1.40-2.00), 1.93 (1.47-2.55), and 4.77 (1.39-16.44), respectively; and boys and girls, 1.62 (1.32-1.98) and 2.01 (1.61-2.50), respectively. CONCLUSION The mortality risk is significantly increased among children with CHD and comorbid CAA. Clinicians should actively seek CAA during the follow-up of children with CHD.
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Affiliation(s)
- Yu-Sheng Lee
- Division of General Pediatrics, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Mei-Jy Jeng
- Division of General Pediatrics, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Pei-Chen Tsao
- Division of General Pediatrics, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Wen-Jue Soong
- Division of General Pediatrics, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan
- * E-mail: (WJS); (PC)
| | - Pesus Chou
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
- * E-mail: (WJS); (PC)
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Lee YS, Chen YT, Jeng MJ, Tsao PC, Yen HJ, Lee PC, Li SY, Liu CJ, Chen TJ, Chou P, Soong WJ. The risk of cancer in patients with congenital heart disease: a nationwide population-based cohort study in Taiwan. PLoS One 2015; 10:e0116844. [PMID: 25706872 PMCID: PMC4338195 DOI: 10.1371/journal.pone.0116844] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 12/15/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The relationship between congenital heart disease (CHD) and malignancies has not been determined. This study aimed to explore the association of CHD with malignancies and examine the risk factors for the development of cancer after a diagnosis of CHD. PATIENTS AND METHODS This nationwide, population-based cohort study on cancer risk evaluated 31,961 patients with newly diagnosed CHD using the Taiwan National Health Insurance Research Database (NHIRD) between 1998 and 2006. The standardized incidence ratios (SIRs) for all and specific cancer types were analyzed, while the Cox proportional hazard model was used to evaluate risk factors of cancer occurrence. RESULTS Among patients with newly diagnosed CHD regardless of ages, 187 (0.6%) subsequently developed cancers after a diagnosis of CHD. Patients with CHD had increased risk of cancer (SIR, 1.45; 95% CI, 1.25-1.67), as well as significantly elevated risks of hematologic (SIR, 4.04; 95% CI, 2.76-5.70), central nervous system (CNS) (SIR, 3.51; 95% CI, 1.92-5.89), and head and neck (SIR, 1.81; 95% CI, 1.03-2.94) malignancies. Age (HR, 1.06; 95% CI, 1.05-1.06) and co-morbid chronic liver disease (HR, 1.91; 95% CI, 1.27-2.87) were independent risk factors for cancer occurrence among CHD patients. CONCLUSION Patients with CHD have significantly increased cancer risk, particularly hematologic, CNS, and head and neck malignancies. Physicians who care for patients with CHD should be aware of their predisposition to malignancy after the diagnosis of CHD. Further studies are warranted to clarify the association between CHD and malignancies.
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Affiliation(s)
- Yu-Sheng Lee
- Division of General Pediatrics, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan; Institute of Public Health and Community Medicine Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yung-Tai Chen
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan
| | - Mei-Jy Jeng
- Division of General Pediatrics, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Pei-Chen Tsao
- Division of General Pediatrics, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Hsiu-Ju Yen
- Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Pediatric Hematology and Oncology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pi-Chang Lee
- Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Pediatric Cardiology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Szu-Yuan Li
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chia-Jen Liu
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pesus Chou
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Wen-Jue Soong
- Division of General Pediatrics, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan
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Fung A, Manlhiot C, Naik S, Rosenberg H, Smythe J, Lougheed J, Mondal T, Chitayat D, McCrindle BW, Mital S. Impact of prenatal risk factors on congenital heart disease in the current era. J Am Heart Assoc 2013; 2:e000064. [PMID: 23727699 PMCID: PMC3698764 DOI: 10.1161/jaha.113.000064] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background The healthcare burden related to congenital heart disease (CHD) is increasing with improving survival. We assessed changing trends in prenatal risk factors for CHD in the current era in a Canadian cohort. Methods and Results CHD patients <18 years old (n=2339) and controls without structural heart disease (n=199) were prospectively enrolled in an Ontario province‐wide biobank registry from 2008–2011. Family history, frequency of extra‐cardiac anomalies (ECAs), and antenatal risk factors were assessed. Temporal trends were analyzed and associations with CHD were measured using linear and logistic regression. Family history of CHD and frequency of major ECAs was higher in cases versus controls (P<0.001). Despite an increase in genetic testing in the recent era, only 9.5% of cases with CHD had a confirmed genetic diagnosis. Yield of genetic testing (ie, frequency of abnormal results) was higher in familial and syndromic cases. There was an increase in parental age at conception, maternal prepregnancy body mass index, maternal urinary tract infections, type 1 diabetes, and exposure to nonfertility medications during pregnancy from 1990–2011. Later year of birth, family history of CHD, presence of major ECAs, maternal smoking during pregnancy, and maternal medication exposure were associated with increased odds of CHD (P<0.05 for all). Advanced parental age was associated with increased odds of CHD caused by genetic abnormalities. Conclusions The increase in prenatal risk factors for CHD highlights the need for more rigorous ascertainment of genetic and environmental factors including gene‐environment interactions that contribute to CHD.
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Affiliation(s)
- Alan Fung
- Division of Cardiology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Cardiopulmonary resuscitation in hospitalized children with cardiovascular disease: estimated prevalence and outcomes from the kids' inpatient database. Pediatr Crit Care Med 2013; 14:248-55. [PMID: 23462352 DOI: 10.1097/pcc.0b013e3182713329] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Hospitalized children with cardiovascular disease may be at increased risk of cardiac arrest; however, little data exist regarding prevalence, risk factors, or outcomes of cardiopulmonary resuscitation in these patients. We sought to characterize national estimates of cardiopulmonary resuscitation and death after cardiopulmonary resuscitation for hospitalized children with cardiovascular disease. SETTING A total of 3,739 hospitals in 38 states participating in Kids' Inpatient Database. DESIGN Retrospective analysis of the 2000, 2003, and 2006 Healthcare Cost and Utilization Project Kids' Inpatient Database was performed. Sample weighting was employed to produce national estimates. MEASUREMENTS AND MAIN RESULTS Cardiovascular disease was identified in 2.2% of the estimated 22,175,468 (95% confidence interval 21,391,343-22,959,592) hospitalizations. Cardiopulmonary resuscitation occurred in 0.74% (3,698; 95% confidence interval 3,205-4,191) of hospitalizations of children with cardiovascular disease, compared with 0.05% (11,726; 95% confidence interval 10,647-12,805) without cardiovascular disease (odds ratio 13.8, 95% confidence interval 12.8-15.0). The highest frequency of cardiopulmonary resuscitation occurred with myocarditis (3.0% of admissions), heart failure (2.0%), and coronary pathology (2.0%). Compared with other forms of cardiovascular disease identified in this study, single-ventricle patients were the only subgroup who exhibited a higher mortality after cardiopulmonary resuscitation (mortality 65% vs. 55%; odds ratio 1.7 [95% confidence interval 1.2-2.6]), while those who had undergone cardiac surgery exhibited a lower mortality rate (mortality 48% vs. 57%; odds ratio 0.6 [95% confidence interval 0.5-0.8]). CONCLUSIONS Cardiopulmonary resuscitation occurs in approximately 7 per 1,000 hospitalizations of children with cardiovascular disease, a rate greater than ten-fold that observed in hospitalizations of children without cardiovascular disease. Single-ventricle patients demonstrated increased mortality after cardiopulmonary resuscitation, while recent cardiac surgery was associated with a reduced odds of death after cardiopulmonary resuscitation. Further studies are needed to confirm these findings and develop techniques to prevent cardiac arrest in this high-risk population.
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Chemin A, Bonnet D, Le Bourgeois M, Levy M, Delacourt C. Respiratory outcome in children with scimitar syndrome. J Pediatr 2013; 162:275-9.e1. [PMID: 22985724 DOI: 10.1016/j.jpeds.2012.07.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 06/08/2012] [Accepted: 07/23/2012] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate respiratory morbidities and lung function tests in the cohort of patients with scimitar syndrome evaluated at our center since 1976. STUDY DESIGN Eighty-one children were investigated. Twenty-six patients died, all with the infantile form. The median duration of follow-up of surviving children was 7.2 years. RESULTS A high rate of respiratory morbidities was measured, with 38% and 43% of children reporting pulmonary infections or wheezing episodes during the last 12 months of follow-up, respectively. One-third of children have been rehospitalized for a respiratory cause. Lung function tests were obtained in 20 children. The median value of total lung capacity was 73.0% of the predicted value (IQR, 65.3-86.8), and the median value of the ratio of the forced expiratory volume in one second to the forced vital capacity was -1.26 Z score (-2.25; -0.31). Significantly lower total lung capacity values were obtained in children with the infantile form (P < .005) or with a history of thoracic surgery (P = .002). The ratio of the forced expiratory volume in one second to the forced vital capacity Z score values were significantly lower in boys (P < .05) and in children with a history of wheezing (P = .01). Wheezing episodes were not associated with significant salbutamol-induced reversibility. CONCLUSION Respiratory complications frequently are observed in children with scimitar syndrome. Pulmonary hypoplasia appears as an independent marker of long-term severity in these patients.
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Affiliation(s)
- Aude Chemin
- Pediatric Pneumology, Necker, AP-HP, Paris, France
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Delacourt C, Hadchouel A, Toelen J, Rayyan M, de Blic J, Deprest J. Long term respiratory outcomes of congenital diaphragmatic hernia, esophageal atresia, and cardiovascular anomalies. Semin Fetal Neonatal Med 2012; 17:105-11. [PMID: 22297025 DOI: 10.1016/j.siny.2012.01.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Intrathoracic congenital malformations may be associated with long-term pulmonary morbidity. This certainly is the case for congenital diaphragmatic hernia, esophageal atresia and cardiac and aortic arch abnormalities. These conditions have variable degrees of impaired development of both the airways and lung vasculature, with a postnatal impact on lung function and bronchial reactivity. Pulmonary complications are themselves frequently associated to non-pulmonary morbidities, including gastrointestinal and orthopaedic complications. These are best recognized in a structured multidisciplinary follow-up clinic so that they can be actively managed.
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Perioperative factors associated with prolonged mechanical ventilation after complex congenital heart surgery. Pediatr Crit Care Med 2011; 12:e122-6. [PMID: 20625334 DOI: 10.1097/pcc.0b013e3181e912bd] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate perioperative factors associated with prolonged mechanical ventilation in children undergoing complex cardiac surgery for congenital heart disease. DESIGN Retrospective chart review. SETTING A tertiary care pediatric cardiac intensive care. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS This retrospective cohort study included all patients undergoing complex cardiac surgical procedures (Risk Adjustment in Congenital Heart Surgery-1 category ≥ 3) at our institution during 2003. We defined prolonged mechanical ventilation as need for mechanical ventilation for ≥ 7 days (90th percentile of duration of mechanical ventilation for the whole cohort). Multivariate logistic regression analyses were used to determine independent relationships between perioperative factors and prolonged mechanical ventilation. A total of 362 patients were admitted to the cardiac intensive care unit after a cardiac surgical procedure of Risk Adjustment in Congenital Heart Surgery-1 ≥ 3 level of complexity and survived to hospital discharge. Median age was 242 days (range, 4 days-14.4 yrs), the median duration of mechanical ventilation was 1.5 days (range, 0-7 days), and 41 patients (11%) were ventilated for ≥ 7 days. Age of <30 days at surgery, higher Pediatric Risk of Mortality III score at the time of cardiac intensive care unit admission, the presence of major noncardiac structural anomalies, healthcare-associated infections, noninfectious pulmonary complications (pleural effusions and pneumothorax), and the need for reintervention were all independently associated with prolonged mechanical ventilation. CONCLUSIONS Younger age, greater severity of illness at postoperative admission, healthcare-associated infections, noninfectious pulmonary complications, and the need for reintervention are associated with prolonged mechanical ventilation after complex cardiac surgery. Future studies and quality improvement initiatives should focus on those risk factors that are modifiable to promote early extubation in children recovering from complex congenital heart surgery.
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Vucetić C, Dulić B, Milaković B, Simić D, Djurasić L, Vukasinović Z. Osteo-articular diseases as comorbidity in non-orthopaedic surgery. ACTA CHIRURGICA IUGOSLAVICA 2011; 58:157-162. [PMID: 21879666 DOI: 10.2298/aci1102157v] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Osteo-articular diseases have significant presence among general population. Osteo-articular disorders can be caused by disease or by trauma. There are many osteo-articular diseases which have influence on general state of the organysm and on other present diseases in a various level. The influence appears by increasing risk of main disease complications, limited movement complicates postoperative treatment of main disease and medicament therapy of osteo-articular disease sometimes modifies perioperative therapy of main disease. Trauma as comorbidity needs urgent care and, in the same time, it is a huge complication for the injured condition. Osteoarticular trauma healing usually lasts several weeks, so it prolongs the healing of intercurrent surgical disease. Osteo-articular changes as comorbidity during the acute surgical disease healing need proper preoperative preparing, With the aim to minimise perioperative morbidity and mortality.
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Morbidity after paediatric cardiac surgery assessed with usage of medicines: a population-based registry study. Cardiol Young 2010; 20:660-7. [PMID: 20723271 DOI: 10.1017/s1047951110000922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the overall morbidity of patients who underwent surgery for congenital cardiac defect during childhood. BACKGROUND A congenital cardiac defect treated with surgery is seldom totally cured. The incidence of residua, sequelae, and comorbidity is quite high. The morbidity has not been thoroughly examined. METHODS AND PATIENTS Medication was used as an indicator of morbidity. Data from the Finnish Research Registry of Paediatric Cardiac Surgery were linked to data from the medication registry of Finland's Social Insurance Institution. This study includes 5116 patients with a mean age of 33.5 (ranged from 14.7 to 64.8) years, who had undergone surgery for congenital cardiac defect between 1953 and 1989. The use of medicines among patients in 2004 was compared with 10232 age- and sex-matched control subjects. RESULTS The overall use of medicines was frequent; 62% of patients and 53% of controls had purchased at least one prescribed medicine (risk ratio: 1.2, 95% confidence interval: 1.1-1.2). The number of patients using cardiovascular medicines (17%) and anti-thrombotic agents (5%) was higher than that of control subjects (risk ratio: 2.2 and 8.4). In addition, the patients needed medicinal care for epilepsy (3%), asthma (7%), and psychiatric diseases (10%) more often than did controls (risk ratio: 2.2, 1.5, and 1.3, respectively). CONCLUSION Patients operated on for congenital cardiac defect had more chronic diseases and used more medicines than did controls.
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Dilber D, Malcić I. Spectrum of congenital heart defects in Croatia. Eur J Pediatr 2010; 169:543-50. [PMID: 19756728 DOI: 10.1007/s00431-009-1064-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Accepted: 08/27/2009] [Indexed: 11/25/2022]
Abstract
The aim of our study was to investigate the incidence of congenital defects in children born in Croatia during a period of 5 years, its association with extracardiac malformations, its treatment, and outcome. Medical information about the patients was obtained from 14 paediatric cardiology centres that cover the whole country. Diagnosis was made by clinical findings, electrocardiography, chest X-ray, echocardiography, catheterisation, or autopsy. Between October 1, 2002 and October 1, 2007, there were 205,051 live births in Croatia, 1,480 of which were patients diagnosed with congenital heart disease, accounting for 0.72% of the live-born children. The distribution was made up of 34.6% children with ventricular septal defect, 15.9% with atrial septal defect, 9.8% with patency of arterial duct, 4.9% with pulmonary valvar stenosis, 3.3% with tetralogy of Fallot, 3.3% with transposed great arteries, 3.3% with aortic stenosis, 3.2% with aortic coarctation, 4.3% with atrioventricular septal defect and common atrioventricular orifice, 2.3% with hypoplastic left heart syndrome, and 8.3% other with severe defects. The average age in the time of diagnoses is 70.41 days (SD, 188.13), with low average time of diagnoses of severe heart defects, 9.6 days (SD, 32.52). Among patients, 14.5% had chromosomal defects, syndromes, and/or other congenital major anomalies. During the study, 57 patients died because of cardiac anomalies or other related problems, 24 who died were operated. The rates of specific cardiac defects and association with extracardiac malformations are generally comparable with those reported in similar studies. In spite of all problems, mortality rate of 3.85% is low but could be improved.
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Affiliation(s)
- Daniel Dilber
- Department of Paediatric Cardiology, University Hospital Zagreb, Zagreb, Croatia.
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Risk factors for central line-associated bloodstream infection in a pediatric cardiac intensive care unit. Pediatr Crit Care Med 2009; 10:453-9. [PMID: 19307818 DOI: 10.1097/pcc.0b013e318198b19a] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To identify risk factors for central line-associated bloodstream infection (BSI) in patients receiving care in a pediatric cardiac intensive care unit. DESIGN Matched case-control study. SETTING CICU at Children's Hospital Boston. PATIENTS Central line-associated BSI cases were identified between April 2004 and December 2006. We identified two randomly selected control patients who had a central vascular catheter and were admitted within 7 days of each index case. MEASUREMENTS AND MAIN RESULTS Univariate and multivariate conditional logistic regression analyses were used to identify risk factors for central line-associated BSI. In a secondary analysis, risk factors for central line-associated BSI in those cases who underwent cardiac surgery were sought. During the study period, 67 central line-associated BSIs occurred in 61 patients. Independent risk factors for central line-associated BSI were nonelective admission for medical management (odds ratio [OR] = 6.51 [1.58-26.78]), the presence of noncardiac comorbidities (OR = 4.95 [1.49-16.49]), initial absolute neutrophil count <5000 cells/uL (OR = 6.17 [1.39-27.48]), blood product exposure > or =3 units (OR = 5.56 [1.35-22.87]), central line days > or =7 (OR = 6.06 [1.65-21.83]), and use of hydrocortisone (OR = 28.94 [2.55-330.37]). In those patients who underwent cardiac surgery (n = 37 cases and 108 controls), independent risk factors for central line-associated BSI were admission weight < or =5 kg (OR = 3.13 [1.01-9.68]), Pediatric Risk of Mortality III score > or =15 (OR = 3.44 [1.19-9.92]), blood product exposure > or =3 units (OR = 3.38 [1.28-11.76]), and mechanical ventilation for > or =7 days (OR = 4.06 [1.33-12.40]). CONCLUSIONS Unscheduled medical admissions, presence of noncardiac comorbidities, extended device utilization, and specific medical therapies are independent risk factors for central line-associated BSI in patients receiving care in a pediatric cardiac intensive care unit.
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Grant EK, Evans MJ. Cardiac findings in fetal and pediatric autopsies: a five-year retrospective review. Pediatr Dev Pathol 2009; 12:103-10. [PMID: 18721004 DOI: 10.2350/08-03-0440.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Accepted: 07/14/2008] [Indexed: 11/20/2022]
Abstract
This review aims to determine the spectrum of cardiac findings in our fetal and pediatric postmortem population and provide an analysis of associated extracardiac malformations and genetic abnormalities. Pediatric autopsy reports from 2003 to 2007 inclusive were reviewed and cases with cardiac pathology selected for analysis. Over the 5-year period, 119 cases (10.8%) with abnormal cardiac findings were identified from a total of 1102 postmortem examinations. Of these cardiac cases, 42% were after termination of pregnancy for fetal anomaly, 29% after fetal demise, 14% after neonatal unit death, 3% after hospital inpatient death, and 11% after sudden unexpected death. Structural abnormality cases numbered 107 (90%), with ventricular septal defect as the most common individual defect. Nonstructural abnormality cases, such as myocarditis, numbered 12 (10%). Extracardiac malformations were identified in 78%. Chromosome or gene aberrations were detected in 37%. This review highlights the potential benefit of introducing routine fetal anomaly scanning, the need for cardiac pathology training for pediatric pathologists, and the importance of examination of the heart and associated vessels in all cases to provide parents with as much information as possible and aid identification of the etiology and associations of cardiac pathology.
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Affiliation(s)
- Elena K Grant
- Department of Pathology, Royal Infirmary of Edinburgh, Edinburgh, UK
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Matthews IL, Kaldestad RH, Bjørnstad PG, Thaulow E, Grønn M. Differing lung function development in infants with univentricular hearts compared with healthy infants. Acta Paediatr 2008; 97:1645-52. [PMID: 18727686 DOI: 10.1111/j.1651-2227.2008.00996.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To compare the difference in lung function development of healthy controls and patients with univentricular hearts from birth prior to surgery and during the first year of life when cardiac shunt procedures and the cavopulmonary connection are required. METHODS Tidal flow-volume measurements and single-occlusion tests were performed from birth serially up to 18 months of age on 28 unsedated spontaneously breathing infants with univentricular hearts and 58 healthy control infants. RESULTS Infants with univentricular heart physiology had low tidal volumes, low compliance of the respiratory system and high respiratory rate at birth, which over time normalized, whereas the peak expiratory flow increased during the study period. The lung function measured at birth was predictive of later lung function measurements. CONCLUSION The pattern of lung function development is different in the patients with univentricular hearts compared to healthy controls. Lung function measured at birth is predictive of later lung function.
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Affiliation(s)
- Iren Lindbak Matthews
- Unit for Paediatric Heart, Lung and Allergic Diseases, Department of Paediatrics, Rikshospitalet University Hospital, Oslo, Norway.
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Waked M, Salameh P. Risk factors for asthma and allergic diseases in school children across Lebanon. J Asthma Allergy 2008; 2:1-7. [PMID: 21437138 PMCID: PMC3048605 DOI: 10.2147/jaa.s3844] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Childhood asthma is one of important diseases of childhood. There is no known prevalence of asthma and allergic diseases in Lebanon. This study was conducted with a secondary objective of finding the odds of exposure to asthma, allergic rhinitis and eczema potential risk factors in Lebanese children. Material and methods: It is a cross-sectional study on children in public and private schools. A sample of 22 schools participated, where standardized written core questionnaires were distributed. 5–12 year old students completed the questionnaires at home, while 13–14 year old students filled it in class. Results: 5522 children were evaluated for asthma, allergic rhinitis and atopic eczema prevalence and their associated factors. These diseases seem to be similarly affected by parental respiratory problems, parental smoking, infancy gastroesophageal reflux, recurrent otitis, and previous pertussis. Humidity on the bedroom walls is associated with both asthma and allergic rhinitis, a spongy pillow with both allergic rhinitis and eczema, animal possession with asthma, and noncotton mattress with atopic eczema. The adjusted odds ratios for significant associations varied between 1.25 and 3 (0.0001 < p-value < 0.01). Conclusion: These factors are preventable, thus permitting a possible reduction of the prevalence of these diseases.
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