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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Birth before 39 weeks' gestation is associated with worse outcomes in neonates with heart disease.
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Birth before 39 weeks' gestation is associated with worse outcomes in neonates with heart disease.

机译：妊娠39周之前的出生与患有心脏病的新生儿的结局较差有关。

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BACKGROUND: Recent studies have revealed increased morbidity and mortality rates in term neonates without birth defects who were delivered before 39 weeks of completed gestation. We sought to determine if a similar association exists between gestational age at delivery and adverse outcomes in neonates with critical congenital heart disease, with particular interest in those born at 37 to 38 weeks' gestation. PATIENTS AND METHODS: We studied 971 consecutive neonates who had critical congenital heart disease and a known gestational age and were admitted to our cardiac ICU from 2002 through 2008. Gestational age was stratified into 5 groups: >41, 39 to 40, 37 to 38, 34 to 36, and <34 completed weeks. Multivariate logistic regression analyses were used to evaluate mortality and a composite morbidity variable. Multivariate Poisson regression was used to evaluate duration of ventilation, intensive care, and hospitalization. RESULTS: Compared with the referent group of neonates who were delivered at 39 to 40 completed weeks' gestation, neonates born at 37 to 38 weeks had increased mortality (6.9% vs 2.6%; adjusted P = .049) and morbidity (49.7% vs 39.7%; adjusted P = .02) rates and tended to require a longer duration of mechanical ventilation (adjusted P = .05). Patients born after 40 or before 37 weeks also had greater adjusted mortality rates, and those born before 37 weeks had increased morbidity rates and required more days of mechanical ventilation and intensive care. CONCLUSIONS: For neonates with critical congenital heart disease, delivery before 39 weeks' gestation is associated with greater mortality and morbidity rates and more resource use. With respect to neonatal mortality, the ideal gestational age for delivery of these patients may be 39 to 40 completed weeks.
机译：背景：最近的研究表明，在没有妊娠缺陷的足月新生儿中，其在完成妊娠39周之前分娩的发病率和死亡率增加。我们试图确定在患有严重先天性心脏病的新生儿分娩时的胎龄与不良结局之间是否存在相似的关联，尤其是对妊娠37至38周的婴儿。患者与方法：我们研究了971例先天性心脏病，已知胎龄的连续新生儿，并于2002年至2008年被纳入我们的心脏ICU。妊娠年龄分为5组：> 41、39至40、37至38 ，34到36和<34周完成。多变量逻辑回归分析用于评估死亡率和综合发病率变量。多元Poisson回归用于评估通气，重症监护和住院时间。结果：与在39至40周完成妊娠分娩的新生儿相比，在37至38周分娩的新生儿死亡率（6.9％vs. 2.6％;校正后的P = .049）和发病率（49.7％vs. 39.7％;调整后的P = .02）率，并且往往需要更长的机械通气时间（调整后的P = .05）。在40周或37周之前出生的患者的调整死亡率也更高，而在37周之前出生的患者的发病率增加，需要更多的时间进行机械通气和重症监护。结论：对于患有严重先天性心脏病的新生儿，在妊娠39周之前分娩与更高的死亡率和发病率以及更多的资源利用有关。关于新生儿死亡率，这些患者分娩的理想胎龄为39至40个完整星期。

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