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Mat Bah MN, Kasim AS, Sapian MH, Alias EY. Survival outcomes for congenital heart disease from Southern Malaysia: results from a congenital heart disease registry. Arch Dis Child 2024; 109:363-369. [PMID: 38296612 DOI: 10.1136/archdischild-2023-326622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/22/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE Limited population-based studies are available on the survival of congenital heart disease (CHD) from lower- and middle-income countries. Therefore, we evaluated the survival from birth until 15 years and associated factors for mortality. METHODS This population-based cohort study included all children with CHD registered in the Pediatric Cardiology Clinical Information System born between 2006 and 2020 in Johor, Malaysia. The mortality rate was calculated, and Cox proportional hazard regression analysis was used to determine factors associated with mortality. The Kaplan-Meier analysis was used to estimate the survival rates at 1, 5, 10 and 15 years. RESULTS There were 5728 patients with CHD studied, with 1543 (27%) lesions resolved spontaneously, 322 (5.6%) were treated with comfort care, 1189 (21%) required no intervention, and 2674 (47%) needed surgery or intervention. The overall mortality rate was 15%, with a median age of death of 3.7 months (IQR 0.9-9.8 months). Preoperative/intervention death was observed in 300 (11%), and 68 (3.2%) children died within 30 days of surgery or intervention. The overall estimated survival at 1, 5, 10 and 15 years was 88%, 85%, 84% and 83%, respectively. The independent factors associated with mortality were male gender, associated syndrome or extra-cardiac defect, pulmonary hypertension, antenatal diagnosis and severe lesions. CONCLUSIONS Eight out of 10 patients with CHDs survived up to 15 years of age. However, 10% of CHDs who require intervention die before the procedure. Thus, improving congenital cardiac surgery and enhancing the overall healthcare system are crucial to improve survival.
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Affiliation(s)
- Mohd Nizam Mat Bah
- Department of Pediatrics, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - Aina Salwa Kasim
- Department of Pediatrics, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - Mohd Hanafi Sapian
- Department of Pediatrics, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
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Çaylan N, Yalçin SS, Tezel B, Üner O, Aydin Ş, Kara F. Investigation of infant deaths associated with critical congenital heart diseases; 2018-2021, Türkiye. BMC Public Health 2024; 24:441. [PMID: 38347475 PMCID: PMC10860226 DOI: 10.1186/s12889-024-17966-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/03/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The aim of this study was to examine the characteristics of infant mortality associated with critical congenital heart disease (CCHD). METHODS In a cross-sectional study, data for the study were obtained through Death Notification System, Birth Notification System and Turkish Statistical Institute birth statistics. RESULTS Of all infant deaths, 9.8% (4083) were associated with CCHD, and the infant mortality rate specific to CCHD was 8.8 per 10,000 live births. CCHD-related infant deaths accounted for 8.0% of all neonatal deaths, while the CCHD specific neonatal death rate was 4.6 per 10,000 live births. Of the deaths 21.7% occurred in the early neonatal, 30.3% in the late neonatal and 48.0% in the post neonatal period. Group 1 diseases accounted for 59.1% (n = 2415) of CCHD related infant deaths, 40.5% (n = 1652) were in Group 2 and 0.4% (n = 16) were in the unspecified group. Hypoplastic left heart syndrome was the most common CCHD among infant deaths (n = 1012; 24.8%). The highest CCHD related mortality rate was found in infants with preterm birth and low birth-weight while multiparity, maternal age ≥ 35 years, twin/triplet pregnancy, male gender, maternal education in secondary school and below, and cesarean delivery were also associated with higher CCHD related infant mortality rate. There was at least one non-cardiac congenital anomaly/genetic disorder in 26.1% of all cases. CONCLUSION CCHD holds a significant role in neonatal and infant mortality in Türkiye. To mitigate CCHD-related mortality rates, it is crucial to enhance prenatal diagnosis rates and promote widespread screening for neonatal CCHD.
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Affiliation(s)
- Nilgün Çaylan
- Child and Adolescent Health Department, Ministry of Health, General Directorate of Public Health, Ankara, Turkey
- Faculty of Medicine, Department of Pediatrics, Division of Social Pediatrics, Hacettepe University, Ankara, 06100, Turkey
| | - Sıddika Songül Yalçin
- Faculty of Medicine, Department of Pediatrics, Division of Social Pediatrics, Hacettepe University, Ankara, 06100, Turkey.
| | - Başak Tezel
- Child and Adolescent Health Department, Ministry of Health, General Directorate of Public Health, Ankara, Turkey
| | - Oben Üner
- Child and Adolescent Health Department, Ministry of Health, General Directorate of Public Health, Ankara, Turkey
| | - Şirin Aydin
- Child and Adolescent Health Department, Ministry of Health, General Directorate of Public Health, Ankara, Turkey
| | - Fatih Kara
- Faculty of Medicine, Department of Public Health, Selçuk University, Konya, Turkey
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3
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Wik G, Jortveit J, Sitras V, Perminow KV, Pripp AH, Døhlen G, Rønnestad A, Holmstrøm H. Detection of severe congenital heart defects in live-born infants in Norway 2017-2020. Acta Paediatr 2024; 113:135-142. [PMID: 37646094 DOI: 10.1111/apa.16953] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 09/01/2023]
Abstract
AIM The aims of this nationwide retrospective cohort study were to determine the time and causes of detection of severe congenital heart defects (CHDs) in live-born infants in Norway between 2017 and 2020. METHODS Information regarding live-born infants with severe CHDs was retrieved from national registries and medical records. RESULTS A total of 219 776 infants were born in Norway from 01.01.2017 to 31.12.2020. Severe CHDs were diagnosed in 442 (0.2%) infants. Of these, 376 (85%) infants were diagnosed either prenatally (n = 203, 46%) or before discharge from hospital after birth (n = 173, 39%). A total of 56 (13%) infants were discharged with undetected CHDs. Time of detection was unknown in 10 cases (2%). The most frequent undetected CHDs at discharge were coarctation of the aorta/aortic arch hypoplasia (n = 24), atrioventricular septal defect (n = 13), anomalous pulmonary venous connection (n = 5) and coronary artery anomalies (n = 4). Seven (13%) children with undetected CHD experienced circulatory collapse out of hospital. CONCLUSION Most infants with severe CHDs in Norway were identified prior to hospital discharge. However, some infants were discharged undiagnosed. Awareness of undetected CHDs and immediate cardiac assessment in infants with signs of circulatory failure early in life are still important.
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Affiliation(s)
- Gunnar Wik
- Department of Paediatric Cardiology, Oslo University Hospital, Oslo, Norway
- Department of Paediatric and Adolescent Medicine, Sorlandet Hospital, Kristiansand, Norway
| | - Jarle Jortveit
- Department of Cardiology, Sorlandet Hospital, Arendal, Norway
| | - Vasilis Sitras
- Department of Obstetrics and Gynaecology, Fetal Medicine Unit, Oslo University Hospital, Oslo, Norway
| | | | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Gaute Døhlen
- Department of Paediatric Cardiology, Oslo University Hospital, Oslo, Norway
| | - Arild Rønnestad
- Department of Neonatal Intensive Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Henrik Holmstrøm
- Department of Paediatric Cardiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Meberg A. We still have a way to go when it comes to detecting critical heart defects. Acta Paediatr 2024; 113:10-12. [PMID: 37814792 DOI: 10.1111/apa.16993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 10/11/2023]
Affiliation(s)
- Alf Meberg
- The Association for Children with Heart Disease, Oslo, Norway
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5
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Çaylan N, Yalçın SS, Tezel B, Üner O, Aydin Ş, Kara F. Evaluation of critical congenital heart disease from 2018 to 2020 in Turkey: a retrospective cohort study. BMC Pregnancy Childbirth 2023; 23:871. [PMID: 38104075 PMCID: PMC10724899 DOI: 10.1186/s12884-023-06193-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND The aim of this study is to examine the features of critical congenital heart disease (CCHD). METHODS The study was planned as a retrospective cohort study. Data for the study were obtained through national data collection systems and 2018-2020 CCHD cohort was established. In this study, we divided the patients into two groups: Group 1 included seven primary target diseases of the newborn CCHD screening program and Group 2 included secondary target diseases. RESULTS There were 9884 CCHD cases, with a prevalence of 27.8 per 10,000 live births. Of the cases 44.4% were in Group 1 (12.3 per 10,000) and 54.8% were in Group 2 (15.2 per 10,000). Of all cases 55.5% were male and the female/male ratio was 1/1.2. While 21.8% of the cases were premature, 23.0% were babies with low birth weight (LBW), 4.8% were born from multiple pregnancies. The highest prevalence of CCHD was found in LBW (84.8 per 10,000), premature infants (57.8 per 10,000) (p < 0.001). The fatality rate in the cohort was 16.6% in the neonatal period, 31.6% in the first year of life respectively. The mean estimated survival time in the birth cohort was 40.0 months (95% CI: 39.5-40.6). The mean survival time for Group 1 diseases was 33.4 months (95% CI: 32.5-34.2), while it was 45.4 months (95% CI: 44.7-46.0) for Group 2 diseases (p < 0.001). Preterm birth, LBW, maternal age and region were evaluated as factors associated with mortality risk. CONCLUSION This study showed that CCHDs are common in Turkey and mortality rates are high. There are regional differences in CCHD both prevalence and survival. Improving prenatal diagnosis rates and expanding neonatal CCHD screening are of key importance.
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Affiliation(s)
- Nilgün Çaylan
- Child and Adolescent Health Department, Ministry of Health, General Directorate of Public Health, Ankara, Turkey
- Department of Social Pediatrics, Hacettepe University Institute of Child Health, Ankara, Turkey
| | - Sıddika Songül Yalçın
- Department of Social Pediatrics, Hacettepe University Institute of Child Health, Ankara, Turkey.
| | - Başak Tezel
- Child and Adolescent Health Department, Ministry of Health, General Directorate of Public Health, Ankara, Turkey
| | - Oben Üner
- Child and Adolescent Health Department, Ministry of Health, General Directorate of Public Health, Ankara, Turkey
| | - Şirin Aydin
- Child and Adolescent Health Department, Ministry of Health, General Directorate of Public Health, Ankara, Turkey
| | - Fatih Kara
- Department of Public Health, Selçuk University Faculty of Medicine, Konya, Turkey
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Hjorth-Johansen E, Børøsund E, Moen A, Harmens A, Martinsen I, Wik G, Fredriksen BE, Eger SHW, Holmstrøm H. Heart OBServation app: development of a decision support tool for parents of infants with severe cardiac disease. Cardiol Young 2023; 33:1350-1358. [PMID: 35938297 DOI: 10.1017/s1047951122002438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Many parents of infants with CHD find it difficult to recognise symptoms of deterioration in their children. Therefore, a personalised decision support application for parents has been developed. This application aims to increase parents' awareness of their infant's normal condition, help them assess signs of deterioration, decide who and when to contact health services, and what to report. The aim of this paper is to describe the concept and report results from a usability study. METHODS An interprofessional group developed a mobile application called the Heart OBServation app in close collaboration with parents using an iterative process. We performed a usability study consisting of semi-structured interviews of 10 families at discharge and after one month and arranged two focus group interviews with nurses caring for these families. A thematic framework analysis of the interviews explored the usability of features in the application. Usability was assessed twice using the System Usability Scale, and a user log was registered throughout the study. RESULTS The overall system usability score, 82.3 after discharge and 81.7 after one month, indicates good system usability. The features of Heart OBServation were perceived as useful to provide tailored information, increase awareness of the child's normal condition, and to guide parents in what to look for. To empower parents, an interactive discharge checklist was added. CONCLUSIONS The Heart OBServation demonstrated good usability and was well received by parents and nurses. Feasibility and benefits of this application in clinical practice will be investigated in further studies.
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Affiliation(s)
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Anne Moen
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Anna Harmens
- South-Eastern Norway Regional Health Authority, Oslo, Norway
| | - Ingeborg Martinsen
- Department of Neonatal Intensive Care, Oslo University Hospital, Oslo, Norway
| | - Gunnar Wik
- Department of Paediatric and Adolescent Medicine, Sorlandet Hospital, Kristiansand, Norway
| | | | - Siw H W Eger
- Department of Neonatal Intensive Care, Oslo University Hospital, Oslo, Norway
| | - Henrik Holmstrøm
- Department of Paediatric Cardiology, Oslo University Hospital, Oslo, Norway and Institute of Clinical Medicine, University of Oslo, Norway
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Erikssen G, Liestøl K, Aboulhosn J, Wik G, Holmstrøm H, Døhlen G, Gjesdal O, Birkeland S, Hoel TN, Saatvedt KJ, Seem E, Thaulow E, Estensen ME, Lindberg HL. Preoperative versus postoperative survival in patients with univentricular heart: a nationwide, retrospective study of patients born in 1990-2015. BMJ Open 2023; 13:e069531. [PMID: 37491095 PMCID: PMC10373731 DOI: 10.1136/bmjopen-2022-069531] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVES Few data exist on mortality among patients with univentricular heart (UVH) before surgery. Our aim was to explore the results of intention to perform surgery by estimating preoperative vs postoperative survival in different UVH subgroups. DESIGN Retrospective. SETTING Tertiary centre for congenital cardiology and congenital heart surgery. PARTICIPANTS All 595 Norwegian children with UVH born alive from 1990 to 2015, followed until 31 December 2020. RESULTS One quarter (151/595; 25.4%) were not operated. Among these, only two survived, and 125/149 (83.9%) died within 1 month. Reasons for not operating were that surgery was not feasible in 31.1%, preoperative complications in 25.2%, general health issues in 23.2% and parental decision in 20.5%. In total, 327/595 (55.0%) died; 283/327 (86.5%) already died during the first 2 years of life. Preoperative survival varied widely among the UVH subgroups, ranging from 40/65 (61.5%) among patients with unbalanced atrioventricular septal defect to 39/42 (92.9%) among patients with double inlet left ventricle. Postoperative survival followed a similar pattern. Postoperative survival among patients with hypoplastic left heart syndrome (HLHS) improved significantly (5-year survival, 42.5% vs 75.3% among patients born in 1990-2002 vs 2003-2015; p<0.0001), but not among non-HLHS patients (65.7% vs 72.6%; p=0.22)-among whom several subgroups had a poor prognosis similar to HLHS. A total of 291/595 patients (48.9%) had Fontan surgery CONCLUSIONS: Surgery was refrained in one quarter of the patients, among whom almost all died shortly after birth. Long-term prognosis was largely determined during the first 2 years. There was a strong concordance between preoperative and postoperative survival. HLHS survival was improved, but non-HLHS survival did not change significantly. This study demonstrates the complications and outcomes encountering newborns with UVH at all major stages of preoperative and operative treatment.
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Affiliation(s)
- Gunnar Erikssen
- Department of Cardiology, Oslo universitetssykehus Rikshospitalet, Oslo, Norway
| | - Knut Liestøl
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Jamil Aboulhosn
- Ahmanson Adult Congenital Heart Disease Center, UCLA, Los Angeles, California, USA
| | - Gunnar Wik
- Department of Pediatrics, Sørlandet Hospital, Kristiansand, Norway
| | - Henrik Holmstrøm
- Department of Women's and Children's, Oslo University Hospital, Oslo, Norway
- Department of Women's and Children's, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gaute Døhlen
- Department of Women's and Children's, Oslo University Hospital, Oslo, Norway
| | - Ola Gjesdal
- Department of Cardiology, Oslo University Hospital rikshospitalet, Oslo, Norway
| | - Sigurd Birkeland
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Tom Nilsen Hoel
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Kjell Johan Saatvedt
- Department of Coardiothoracic Surgery, Oslo universitetssykehus Rikshospitalet, Oslo, Norway
| | - Egil Seem
- Department of Coardiothoracic Surgery, Oslo universitetssykehus Rikshospitalet, Oslo, Norway
| | - Erik Thaulow
- Department of Pediatric Cardiology, Oslo universitetssykehus Rikshospitalet, Oslo, Norway
| | - Mette E Estensen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
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Hjorth-Johansen E, Børøsund E, Martinsen Østen I, Holmstrøm H, Moen A. Acceptability and Initial Adoption of the Heart Observation App for Infants with Congenital Heart Disease: A Qualitative Study (Preprint). JMIR Form Res 2023; 7:e45920. [PMID: 37018028 PMCID: PMC10131881 DOI: 10.2196/45920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Approximately 1% of all infants are born with a congenital heart disease (CHD). Internationally CHD remains a major cause of infant death, some of which occur unexpectedly after a gradual deterioration at home. Many parents find it difficult to recognize worsening of symptoms. OBJECTIVE This study aims to report the acceptability and initial adoption of a mobile app, the Heart Observation app (HOBS), aiming to support parents' understanding and management of their child's condition and to increase quality in follow-up from health care professionals in complex health care services in Norway. METHODS A total of 9 families were interviewed on discharge from the neonatal intensive care unit and after 1 month at home. The infant's primary nurse, community nurse, and cardiologist were also interviewed regarding their experiences about collaboration with the family. The interviews were analyzed inductively with thematic content analysis. RESULTS The analysis generated 4 main themes related to acceptability and adoption: (1) Individualize Initial Support, (2) Developing Confidence and Coping, (3) Normalize When Appropriate, and (4) Implementation in a Complex Service Pathway. The receptivity of parents to learn and attend in the intervention differs according to their present situation. Health care professionals emphasized the importance of adapting the introduction and guidance to parents' receptivity to ensure comprehension, self-efficacy, and thereby acceptance before discharge (Individualize Initial Support). Parents perceived that HOBS served them well and nurtured confidence by teaching them what to be aware of. Health care professionals reported most parents as confident and informed. This potential effect increased the possibility of adoption (Developing Confidence and Coping). Parents expressed that HOBS was not an "everyday app" and wanted to normalize everyday life when appropriate. Health care professionals suggested differentiating use according to severity and reducing assessments after recovery to adapt the burden of assessments when appropriate (Normalize When Appropriate). Health care professionals' attitude to implement HOBS in their services was positive. They perceived HOBS as useful to systemize guidance, to enhance communication regarding an infant's condition, and to increase understanding of heart defects in health care professionals with sparse experience (Implementation in a Complex Service Pathway). CONCLUSIONS This feasibility study shows that both parents and health care professionals found HOBS as a positive addition to the health care system and follow-up. HOBS was accepted and potentially useful, but health care professionals should guide parents initially to ensure comprehension and adapt timing to parents' receptivity. By doing so, parents may be confident to know what to look for regarding their child's health and cope at home. Differentiating between various diagnoses and severity is important to support normalization when appropriate. Further controlled studies are needed to assess adoption, usefulness, and benefits in the health care system.
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Affiliation(s)
- Elin Hjorth-Johansen
- Neonatal Intensive Care Unit, Division of Children and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Ingeborg Martinsen Østen
- Neonatal Intensive Care Unit, Division of Children and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Henrik Holmstrøm
- Department of Cardiology, Division of Children and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Moen
- Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Hendon E, Kane J, Golem GM, McBroom A, Flores S, Wong J, Villarreal EG, Loomba RS. Acute effects of vasoactive medications in patients with parallel circulation awaiting hybrid or Norwood procedure. Ann Pediatr Cardiol 2022; 15:34-40. [PMID: 35847409 PMCID: PMC9280101 DOI: 10.4103/apc.apc_39_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022] Open
Abstract
Background Vasoactive medications are frequently used in the preoperative stage to balance the pulmonary and systemic blood flow. However, not much is known about the effects of these agents during this stage. Aims The primary objective of this study was to characterize the acute effects of vasoactive medications in children with parallel circulation before either the hybrid or Norwood procedure. Setting and Designs This is a single-center, cross-sectional, retrospective study. Methods Hemodynamic and systemic oxygen delivery data were captured from patients' vital signs, arterial blood gases, near-infrared spectroscopy monitoring (NIRS). Data for each patient were collected before the initiation of a vasoactive medication and again 6 h after. Statistical Analysis Data were analyzed using paired t-tests, and analysis of covariance. Results A total of 139 patients were identified. After data extraction the following patients were included before the initial intervention: 7 were on milrinone, 22 were on dopamine, and 17 were on dobutamine. Dopamine and dobutamine were found to significantly increase systolic blood pressure. Only dopamine increased pH (mean difference 0.04), decreased paCO2 (mean difference -7.1), decreased lactate (mean difference -0.6 mmol/L), and decreased in bedside Qp: Qs (mean difference -7.5) after continuous infusion for 6 h. Milrinone was not associated with any significant hemodynamic change. Conclusion In this study, dopamine was independently associated with improvement in markers of systemic oxygen delivery 6 h after initiation. Dobutamine and dopamine were associated with increased in blood pressure. Well-powered studies are required to detect changes in lactate and NIRS.
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Affiliation(s)
- Emily Hendon
- Pediatric Cardiology, Advocate Children's Hospital, Chicago, IL, USA
| | - Jennifer Kane
- Pediatric Cardiology, Advocate Children's Hospital, Chicago, IL, USA
| | - Gina M. Golem
- Pediatric Cardiology, Advocate Children's Hospital, Chicago, IL, USA
| | - Amanda McBroom
- Pediatric Cardiology, Advocate Children's Hospital, Chicago, IL, USA
| | - Saul Flores
- Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA,Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Joshua Wong
- Pediatric Cardiology, Advocate Children's Hospital, Chicago, IL, USA
| | - Enrique G. Villarreal
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico,Address for correspondence: Dr. Enrique G. Villarreal, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, Nuevo Leon, Mexico. E-mail:
| | - Rohit S. Loomba
- Pediatric Cardiology, Advocate Children's Hospital, Chicago, IL, USA,Department of Pediatrics, Chicago Medical School/ Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
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10
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Wik G, Jortveit J, Sitras V, Døhlen G, Rønnestad AE, Holmstrøm H. Unexpected death in children with severe congenital heart defects in Norway 2004-2016. Arch Dis Child 2021; 106:961-966. [PMID: 33597179 PMCID: PMC8461410 DOI: 10.1136/archdischild-2020-319936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 01/03/2021] [Accepted: 01/14/2021] [Indexed: 11/18/2022]
Abstract
AIMS Updated knowledge on the rates and causes of death among children with severe congenital heart defects (CHDs) is needed to further improve treatment and survival. This study investigated nationwide mortality rates in children with severe CHDs with an emphasis on unexpected mortality unrelated to cardiac intervention. METHODS AND RESULTS Data on all pregnancies and live-born children in Norway from 2004 to 2016 were obtained from national registries, the Oslo University Hospital's Clinical Registry for CHDs and medical records. Among 2359 live-born children with severe CHDs, 234 (10%) died before 2 years of age. Of these, 109 (46%) died in palliative care, 58 (25%) died of causes related to a cardiac intervention and 67 (29%) died unexpectedly and unrelated to a cardiac intervention, either before (n=26) or following (n=41) discharge after a cardiac intervention. Comorbidity (38/67, 57%), persistent low oxygen saturation (SaO2; <95%; 41/67, 61%), staged surgery (21/41, 51%), residual cardiac defects (22/41, 54%) and infection (36/67, 54%) were frequent in children who died unexpectedly unrelated to an intervention. Two or more of these factors were present in 62 children (93%). The medical reports at hospital discharge lacked information on follow-up in many patients who died unexpectedly. CONCLUSIONS The numbers of unexpected deaths unrelated to cardiac intervention in children <2 years of age without comorbidity were low in Norway. However, close follow-up is recommended for infants with comorbidities, persistent low oxygen saturation, staged surgery or residual cardiac defects, particularly when an infection occurs.
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Affiliation(s)
- Gunnar Wik
- Department of Paediatric Cardiology, Oslo University Hospital, Oslo, Norway .,Department of Paediatric and Adolescent Medicine, Sorlandet Hospital Kristiansand, Kristiansand, Norway
| | - Jarle Jortveit
- Department of Cardiology, Sørlandet Hospital Arendal, Arendal, Norway
| | - Vasileios Sitras
- Department of Obstetrics and Gynaecology, Fetal Medicine Unit, Oslo University Hospital, Oslo, Norway
| | - Gaute Døhlen
- Department of Paediatric Cardiology, Oslo University Hospital, Oslo, Norway
| | - Arild E Rønnestad
- Women and Children’s Division, Department of Neonatal Intensive Care, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Henrik Holmstrøm
- Department of Paediatric Cardiology, Oslo University Hospital, Oslo, Norway
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11
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Bonnet D. Impacts of prenatal diagnosis of congenital heart diseases on outcomes. Transl Pediatr 2021; 10:2241-2249. [PMID: 34584895 PMCID: PMC8429871 DOI: 10.21037/tp-20-267] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/21/2020] [Indexed: 12/02/2022] Open
Abstract
Prenatal diagnosis of congenital heart diseases (CHD) is increasingly performed in developed countries. Still, the current impacts of prenatal diagnosis on fetal and neonatal outcomes remains unclear or contradictory. We will review here the different consequences of prenatal screening and of fetal echocardiography on different categories of outcomes. Increasing detection may lead to a reduced birth incidence of severe complex CHD through a high rate of termination of pregnancy but this trend is not universal. Conversely, one of the main impacts of prenatal diagnosis is to optimize perinatal care and to improve hard outcomes such as mortality. Indeed, decrease of neonatal mortality is inconsistently observed in transposition of the great arteries and is not shown in other defects. The reduction of perinatal morbidity is a new end-point to scrutinize but how to examine this impact is controversial in the neonatal period. The influence of the reduction of neonatal distress may modify neurodevelopmental outcomes and quality of survival. The risk stratification after a prenatal diagnosis of CHD helps to optimize the timing, mode, and site of management with the aim to improve outcomes. The anticipated care is tailored according to the type of CHD and expected initial physiology. However, the imprecision of prenatal diagnosis even in expert centers hampers this logical outcome. Prediction of the type of repair is theoretically possible but remains challenging in defects such as double outlet right ventricles or pulmonary atresia with ventricular septal defect. The cost of prenatal diagnosis or of its absence is still a matter of debate and policies have to be tailored to regional health systems. Finally, the impact on parents and siblings is a rarely explored outcome. Screening and echography of fetal heart are currently performed in developed countries but it is still too early to talk about fetal cardiology.
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Affiliation(s)
- Damien Bonnet
- M3C-Necker, Hôpital universitaire Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
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