| Part one:a survey of prenatal influencing factors of 44 critical congenital heart diseasesObjectiveTo explore the prenatal influencing factors of critical congenital heart disease,to provide scientific basis for screening critical congenital heart disease.MethodsBased on a case-control study,44 critical congenital heart disease children were selected from the Children's Hospital of Soochow University during the period from January 01,2016 to April 30,2019,which were confirmed by color Doppler echocardiography in our hospital,as the case group.According to the matched conditions,the newborns with non-congenital heart disease were selected as the control group.A unified questionnaire was used for the pregnant women in the case group and the control group,and the same doctor checked the case and returned the telephone visit.The contents include:the basic situation of newborn,pregnant women before and during pregnancy,family history and so on.Risk factors using SPSS20.0 statistical software package Single factor analysis of prime and regression analysis of multi-factor Logistic.ResultsThe results of univariate analysis showed that the maternal age,pregnancy times,education level,respiratory tract infection during pregnancy,folic acid intake during pregnancy,placental bleeding/abortion symptoms during early pregnancy,pregnancy complications,and residence during pregnancy had environmental pollution sources,Maternal abnormal birth history is associated with the occurrence of critical congenital heart disease.Multivariate conditional regression analysis showed that the age of first trimester,respiratory tract infection during pregnancy and folic acid administration during pregnancy were independent factors associated with the occurrence of critical congenital heart disease.Conclusion(1)The risk factors related to critical congenital heart disease are as follows:maternal age,pregnancy times,respiratory tract infection during pregnancy,placental bleeding/abortion symptoms in early pregnancy,pregnancy complications,environmental pollution sources in place of residence during pregnancy,abnormal birth history of parturients,etc.(2)The protective factors conducive to reducing the risk of critical congenital heart disease are:mothers with a high level of education and take folic acid on time.(3)Moderate work during pregnancy had no significant effect on children.The second part:Clinical characteristics and prognosis of critical congenital Heart Disease in NeonatesObjectiveThe first diagnosis symptoms,admission mode,surgical treatment and prognosis of critical congenital heart disease children who were hospitalized in our hospital in the last 3 years were analyzed.To explore the effect of early diagnosis and treatment on survival rate of children with critical congenital heart disease and the role of the integrated system of diagnosis and treatment of perinatal critical congenital heart disease in the diagnosis and treatment of children with critical congenital heart disease.MethodsThe clinical data of 44 neonates with critical congenital heart disease admitted in our hospital from January 2016 to April 2019 were retrospectively analyzed,including basic information(name,hospital number,mode of delivery,number of births,weight,sex).Admission(main complaint,respiration,heart rate,percutaneous,admission diagnosis),echocardiographic reporting(prenatal echocardiography,post-hospitalization echocardiography),,surgical conditions(age at the time of operation,length of stay in hospital,name of operation),prognosis(5 aspects,such as automatic discharge,death,cure,etc.,were analyzed retrospectively,counting data,using cases and percentage.Results(1)The initial diagnosis of 44 children with CCHD was analyzed.The results showed that the blood oxygen saturation was less than 95%in 139 cases(88.6%),and 33 cases(75.0%)had different degrees of cyan and purple.Turquoise occurred in 27 cases(61.4%)within 24 hours after birth.Cardiac murmur was found in 230 cases(68.2%),of which 16 cases(36.4%)appeared 24 hours after birth,32 cases(4.5%)had extracardiac malformation,4 cases(13.6%)had yellow skin staining,and 6 cases(13.6%)had cardiac murmur.522 cases(50%)developed respiratory symptoms of varying degrees,of which 522 cases(50%)developed respiratory symptoms of varying degrees.20 cases(45.5%)had shortness of breath and 2 cases(4.5%)had cough.(2)Diagnosis,treatment and prognosis:the time of detection of cardiac malformation was divided into three stages:antenatal screening,neonatal screening and non-neonatal screening.The diagnosis,treatment and prognosis of the three groups were compared and analyzed,and the results were as follows.?The cure rate and mortality rate of the three groups were compared and analyzed.the results showed that the cure rate of the children in the antenatal screening group was the highest,followed by the neonatal stage,the non-neonatal screening group,and the mortality of the three groups was the opposite.?the analysis of the cause of death showed that the postoperative mortality of the patients in the non-neonatal screening group was the highest among the three groups before operation,followed by the neonatal screening group,while there were no preoperative and postoperative deaths in the antenatal screening group.Among the three groups,the rate of rejection of surgical treatment was the highest in the antenatal screening group.?Analysis of postoperative recovery:8 cases,18 cases and 3 cases were cured in antenatal screening,neonatal screening and non-neonatal screening,respectively.The results showed that the proportion of children in antenatal screening group was the highest when tracheal intubation was removed within 6 days after operation,and transferred to general ward within 10 days and the total hospitalization time was less than 20 days.The second group was neonatal screening group and non-neonatal screening group.(3)Referrals and prognosis:the relationship between admission time and prognosis of 44 children with CCHD was statistically analyzed.the results showed that the children transferred to the children's heart hospital for professional treatment within 24 hours after birth.The average length of hospitalization and mortality were lower than those of children over 24 hours.Conclusion(1)POX,and cardiac murmur have the highest sensitivity in CCHD screening.(2)The early diagnosis and treatment of neonatal CCHD during parturient period is beneficial to improve the survival rate of CCHD children and reduce the economic burden of their families.(3)Timely and effective transport between obstetrical hospitals and specialized cardiac hospitals for children is helpful to reduce CCHD. |
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