Investigation On The Incidence And Prognosis Of Congenital Heart Disease In Hospitalized Premature Infants In Suzhou Area

Objective:This research analysis the incidence,mortality,type,clinical characteristics and other data of the hospitalized premature infants with congenital heart disease to better understand the epidemiological characteristics of the hospitalized premature infants with congenital heart disease.Methods:Clinical data were analyzed for neonates with congenital heart disease diagnosed by cardiac color Doppler ultrasound in the children's hospital affiliated to soochow university during January 1,2017-December 31,2017.The premature infants were the observation group and the full-term infants were the control group.The differences in the incidence,type,clinical signs and symptoms,pregnancy status,and laboratory equipment test results of congenital heart disease between the two groups were analyzed.The clinical data of the prevalence of congenital heart disease in premature infants of different gestational ages and birth weights were analyzed.The prognosis of various types of congenital heart disease at the age of one year were also analyzed.The 27 factors associated with congenital heart disease in hospitalized premature infants were by using single factor analysis,including gender,gestational age,birth weight,heart murmur,exposure to pets during pregnancy,maternal age,etc.Variables with statistical significance were included in multivariate Logistic regression for analysis.Results:1.The incidence of congenital heart disease among hospitalized neonates was 10.7%,the premature infants and full-term infants was 18.7%and 8.1%,respectively.The difference between the two groups was statistically significant(P<0.05).2.In premature infants and full-term infants with isolated congenital heart disease,the highest proportion was isolated atrial septal defect,followed by isolated patent ductus arteriosus.The incidence of premature infants were higher than that of full-term infants(P<0.05).In combined congenital heart diseases,the incidence of atrial septal defect+patent ductus arteriosus were the highest in preterm and term infants,there was significant difference between the two groups(P<0.05).The incidence of complex congenital heart disease were very low in both two groups and there was no statistically significant(P>0.05).3.The incidence of premature infants with isolated atrial septal defect above 5mm was lower than that of full-term infants,but the difference between the two groups was not statistically significant(P>0.05).4.Premature infants have a higher rate of shortness of breath,three concave signs,low pulse oxygen,intrauterine growth and development,in vitro fertilization,older mothers and mothers with gestational diabetes,gestational hypertension,abortion history,or cesarean section than the full-term infants.The difference between two groups was statistically significant(P<0.05).5.The incidence of congenital heart disease among premature infants at 28?29+6 weeks(birth weight<1000g)was the highest.In the composition of congenital heart disease,the isolated patent ductus arteriosus had the highest proportion in preterm infants at<28 weeks,and the proportion in the gestational age group showed a decreasing trend.Isolated atrial septal defect had the highest proportion in each gestational age(except<28 weeks group),and its proportion in each gestational age group is about 50%.Among combined congenital heart diseases,atrial septal defect+patent ductus arteriosus account for the highest proportion in all group of gestational ages.Patients with complex congenital heart diseases were all near full-term infants.6.The follow-up results of congenital heart disease in premature infants at one year old:the healing rate was 69.8%,(66.5%of natural healing,1.4%of drug healing and surgical healing was 1.9%),unhealed was 16.6%,death was 2.8%,and lost to follow-up was 11%.7.The exposure to pets during pregnancy,gestational age,birth weight,shortness of breath,cyanosis,cardiac murmur,three concave sign,chest X-ray changes,and percutaneous oxygen saturation<93%had statistically significant by univariate analysis(P<0.05).Multivariate logistic regression analysis showed that cardiac murmur(OR=27.767),shortness of breath(OR=1.982),exposure to pets during pregnancy(OR=10.201),and chest X-ray cardiac imaging changes(OR=1.930)and birth weight(OR=0.999)were independent factors for congenital heart disease in premature infants.Conclusions:1.The incidence of congenital heart disease(including isolated patent ductus arteriosus)in hospitalized premature infants was 18.7%,and the mortality rate was 2.8%2.The mainly types of the congenital heart disease were isolated atrial septal defect and isolated patent ductus arteriosus.The incidence of complex congenital heart disease was low.3.The premature infants with congenital heart disease had a high natural healing rate,and most prognosis is good.But the prognosis of complex congenital heart disease or severe congenital heart disease were poor without treatment.4.Mothers should avoid pets exposure during pregnancy to reduce the incidence of congenital heart disease in premature infants.5.For premature infants with cardiac murmur,shortness of breath,chest X-ray cardiac imaging changes and low birth weight,clinicians should be use echocardiogram to screen for congenital heart disease early.