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New modified version of the Risk Adjustment for Congenital Heart Surgery category and mortality in premature infants with critical congenital heart disease

Clinical and Experimental Pediatrics 2020년 63권 10호 p.395 ~ 401
윤영미, 배성필, 김윤주, 곽재건, 김웅한, 송미경, 신승한, 김이경, 김한숙,
소속 상세정보
윤영미 ( Yoon Young-Mi ) - Jeju National University Hospital Department of Pediatrics
배성필 ( Bae Seong-Phil ) - Soonchunhyang University Hospital Department of Pediatrics
김윤주 ( Kim Yoon-Joo ) - Jeju National University Hospital Department of Pediatrics
곽재건 ( Kwak Jae-Gun ) - Seoul National University Children’s Hospital Department of Thoracic and Cardiovascular Surgery
김웅한 ( Kim Woong-Han ) - Seoul National University Children’s Hospital Department of Thoracic and Cardiovascular Surgery
송미경 ( Song Mi-Kyoung ) - Seoul National University Children’s Hospital Department of Pediatrics
신승한 ( Shin Seung-Han ) - Seoul National University Children’s Hospital Department of Pediatrics
김이경 ( Kim Ee-Kyung ) - Seoul National University Children’s Hospital Department of Pediatrics
김한숙 ( Kim Han-Suk ) - Seoul National University Children’s Hospital Department of Pediatrics

Abstract


Background: Despite advances in neonatal intensive care and surgical procedures, perinatal mortality rates for premature infants with congenital heart disease (CHD) remain relatively high.

Purpose: We aimed to describe the outcomes of premature infants with critical CHD and identify the risk factors including the new modified version of the Risk Adjustment for Congenital Heart Surgery (M-RACHS) category associated with in-hospital mortality in a Korean tertiary center.

Methods: This was a retrospective cohort study of premature infants with critical CHD admitted to the neonatal intensive care unit from January 2005 to December 2016.

Results: A total of 78 premature infants were enrolled. The median gestational age (GA) at birth was 34.9 weeks (range, 26.7?36.9 weeks), and the median birth weight was 1.91 kg (range, 0.53?4.38 kg). Surgical or percutaneous intervention was performed in 68 patients with a median GA at birth of 34.7 weeks (range, 26.7?36.8 weeks) and a median birth weight of 1.92 kg (range, 0.53?4.38 kg). The in-hospital survival rate was 76.9% among all enrolled preterm infants and 86.8% among patients who received an intervention. Very low birth weight (VLBW), persistent pulmonary hypertension of the newborn (PPHN), bronchopulmonary dysplasia (BPD), and M-RACHS category 5 or higher (more complex CHD) were independently associated with in-hospital mortality. For the 68 premature infants undergoing cardiac interventions, independent risk factors for mortality were VLBW, BPD, and CHD complexity. Late preterm infant and age at intervention were not associated with patient survival.

Conclusion: For premature infants with critical CHD, VLBW, PPHN, BPD, and M-RACHS category ≥5 were risk factors for mortality. A careful approach to surgical intervention and prenatal care should be taken according to CHD type and neonatal condition.

키워드

Congenital heart disease; Mortality; Outcome; Premature

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