Congenital Heart Disease最新文献

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Association of congenital heart defects (CHD) with factors related to maternal health and pregnancy in newborns in Puerto Rico. 波多黎各新生儿先天性心脏缺陷 (CHD) 与产妇健康和怀孕相关因素的关系。

IF 0.3 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Congenital Heart Disease

Pub Date : 2024-01-01 Epub Date: 2024-03-20 DOI: 10.32604/chd.2024.046339

Yamixa Delgado, Caliani Gaytan, Naydi Perez, Eric Miranda, Bryan Colón Morales, Mónica Santos

Background: Given the pervasive issues of obesity and diabetes both in Puerto Rico and the broader United States, there is a compelling need to investigate the intricate interplay among BMI, pregestational, and gestational maternal diabetes, and their potential impact on the occurrence of congenital heart defects (CHD) during neonatal development.

Methods: Using the comprehensive System of Vigilance and Surveillance of Congenital Defects in Puerto Rico, we conducted a focused analysis on neonates diagnosed with CHD between 2016 and 2020. Our assessment encompassed a range of variables, including maternal age, gestational age, BMI, pregestational diabetes, gestational diabetes, hypertension, history of abortion, and presence of preeclampsia.

Results: A cohort of 673 patients was included in our study. The average maternal age was 26 years, within a range of 22 to 32 years. The mean gestational age measured 39 weeks, with a median span of 38 to 39 weeks. Of the 673 patients, 274 (41%) mothers gave birth to neonates diagnosed with CHD. Within this group, 22 cases were linked to pre-gestational diabetes, while 202 were not; 20 instances were associated with gestational diabetes, compared to 200 without; and 148 cases exhibited an overweight or obese BMI, whereas 126 displayed a normal BMI.

Conclusion: We identified a statistically significant correlation between pre-gestational diabetes mellitus and the occurrence of CHD. However, our analysis did not show a statistically significant association between maternal BMI and the likelihood of CHD. These results may aid in developing effective strategies to prevent and manage CHD in neonates.

背景：鉴于肥胖和糖尿病问题在波多黎各和更广泛的美国都很普遍，因此迫切需要研究 BMI、妊娠前和妊娠期母亲糖尿病之间错综复杂的相互作用，以及它们对新生儿发育期间先天性心脏缺陷（CHD）发生的潜在影响：我们利用波多黎各先天性缺陷警戒和监测综合系统，对 2016 年至 2020 年期间确诊为先天性心脏病的新生儿进行了重点分析。我们的评估涵盖了一系列变量，包括产妇年龄、胎龄、体重指数、妊娠糖尿病、妊娠期糖尿病、高血压、流产史和是否存在先兆子痫：我们的研究共纳入了 673 名患者。产妇的平均年龄为 26 岁，在 22 至 32 岁之间。平均孕周为 39 周，中位数为 38 至 39 周。在 673 名患者中，有 274 名（41%）母亲所生的新生儿被诊断出患有先天性心脏病。在这一群体中，22 例与妊娠前糖尿病有关，202 例与妊娠前糖尿病无关；20 例与妊娠糖尿病有关，200 例与妊娠糖尿病无关；148 例显示超重或肥胖体重指数，126 例显示正常体重指数：结论：我们发现妊娠前期糖尿病与冠心病的发生之间存在统计学意义上的显著相关性。结论：我们发现妊娠前期糖尿病与冠心病的发生在统计学上有明显的相关性，但我们的分析并未显示孕产妇体重指数与冠心病发生的可能性在统计学上有明显的相关性。这些结果可能有助于制定预防和控制新生儿先天性心脏病的有效策略。

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Congenital Heart Disease

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Dongyun Bie, Hongbai Wang, Chaobin Zhang, Chunrong Wang, Yuan Jia, Su Yuan, Sheng Shi, Jiangshan Huang, Jianhui Wang, Fuxia Yan

Purpose: This study sought to explore the effect of intraoperative mean blood glucose levels and variability on postoperative acute kidney injury (AKI) in children undergoing congenital cardiac surgery. Methods: We conducted a prospective nested case-control study in children (age < 18 years) undergoing congenital heart surgery with cardiopulmonary bypass (CPB) at the Fuwai Hospital between April 01, 2022 and July 30, 2022. Cases were individuals who developed AKI within the first postoperative 7 days (AKI group) and controls were those without AKI (Non-AKI group) according to KDIGO criteria. AKI and Non-AKI groups unmatched and 1:1 matched by age, sex, and baseline serum creatinine were separately analyzed. Multivariate logistic and conditional logistic regressions were used to assess the associations between blood glucose variables and AKI. Results: 688 consecutively approached patients were included in the final analysis. On multivariate analysis, intra-CPB (adjusted odds ratio [OR] 0.802; 95% confidence interval [CI], 0.706 to 0.912; p = 0.001) and post-CPB (adjusted OR 0.830; 95% CI, 0.744 to 0.925; p = 0.001) blood glucose levels were associated with postoperative AKI. There were no significant differences in pre-CPB blood glucose (adjusted OR 0.926; 95% CI, 0.759 to 1.129; p = 0.446) or intraoperative glycemic fluctuations (adjusted OR 0.905; 95% CI, 0.723 to 1.132; p = 0.382) between AKI and Non-AKI groups. Results based on matched cases and controls were consistent with those from the unmatched analyses. Conclusion: Higher intraoperative blood glucose levels during and after CPB were protective factors against postoperative AKI in pediatric patients after congenital heart surgery.

目的:本研究旨在探讨术中平均血糖水平和变异性对先天性心脏手术患儿术后急性肾损伤(AKI)的影响。方法:对2022年4月1日至2022年7月30日在阜外医院行先天性心脏手术合并体外循环(CPB)的儿童(年龄< 18岁)进行前瞻性巢式病例对照研究。病例为术后第一个7天内发生AKI的个体(AKI组)，对照为根据KDIGO标准无AKI的个体(非AKI组)。AKI组和非AKI组按年龄、性别和基线血清肌酐不匹配和1:1匹配分别进行分析。采用多变量logistic回归和条件logistic回归来评估血糖变量与AKI之间的关系。结果:688例连续就诊的患者被纳入最终分析。多变量分析中，intra-CPB(调整优势比[OR] 0.802;95%置信区间[CI]， 0.706 ~ 0.912;p = 0.001)和cpb后(调整OR 0.830;95% CI, 0.744 ~ 0.925;p = 0.001)血糖水平与术后AKI相关。cpb前血糖差异无统计学意义(调整OR 0.926;95% CI, 0.759 ~ 1.129;p = 0.446)或术中血糖波动(调整or 0.905;95% CI, 0.723 ~ 1.132;p = 0.382)。匹配病例和对照的结果与未匹配分析的结果一致。结论:CPB期间和之后较高的术中血糖水平是儿童先心病术后AKI的保护因素。

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