Kritik konjenital kalp hastalığı olan yenidoğanların nakil sonuçlarının ameliyat süresi ve mortalite oranlarına etkisi

Year 2024, Volume: 49 Issue: 1, 62 - 70, 29.03.2024

Tugay Tepe , Ahmet İbrahim Kurtoğlu , Hacer Yapıcıoğlu , Mustafa Özdemir , Nejat Narlı , Ferda Özlü , Sevcan Erdem , İlker Ünal

https://doi.org/10.17826/cumj.1379435

Abstract

Amaç: Kritik konjenital kalp hastalığı (KKKH) olan yenidoğanların nakli, profesyonel ve deneyimli personelin yanı sıra hem girişim hem de ameliyat sonrası bakım için tam donanımlı tesisler gerektirir. Bu çalışmada, KKKH olan yenidoğanlarda naklin, ameliyat süresi ve sağ kalım üzerine etkisini değerlendirmeyi ve nakil özellikleri ile klinik durum arasındaki ilişkiyi belirlemeyi amaçladık.
Gereç ve Yöntem: Üniversite hastanesine 1 Ocak 2019 ile 31 Aralık 2019 tarihleri arasında nakledilen tüm KKKH olan bebekler üzerinde retrospektif kesitsel bir kohort çalışması gerçekleştirildi. Nakil mesafesi, eşlik eden sağlık çalışanı, vital bulgular, oksijen satürasyon seviyeleri, prostaglandin E1 (PGE) kullanımı ve solunum desteği gibi nakil özellikleri kaydedildi. Nakil özelliklerinin ameliyat süresi, komplikasyonlar ve mortalite üzerindeki etkileri analiz edildi. Konjenital kalp hastalığı için mortalite ile ilişkili riskleri analiz etmek için Göğüs Cerrahları Derneği-Avrupa Kardiyo-Torasik Cerrahi Derneği (STAT) Skoru kullanıldı. Bu hastalar hastanemizde doğan KKKH'lı yenidoğanlarla karşılaştırıldı.
Bulgular: Toplam 55 kritik konjenital kalp hastalığı tanılı hasta değerlendirildi. Otuz bir yenidoğan (%56,4) hastanemizde doğdu (Hastane grubu) ve 24 yenidoğan (%43,6) başka bir merkezden transfer edildi (Hastane dışı grup). Gruplar arasında cinsiyet, gebelik yaşı, doğum ağırlığı, ameliyat öncesi süre ve hastanede kalış süresi açısından fark yoktu. Hastane dışından gelen grupta daha az ciddi STAT skor kategori hastası olmasına rağmen, 30 günlük sağkalım veya ölüm oranlarında fark yoktu. Hastane dışı grubunda, duktus bağımlı KKKH olan beş hasta (%20,8) PGE tedavisi uygulanmadan nakledilmiş ve duktus bağımlı altı hastaya (%25) nakil sırasında uygunsuz şekilde oksijen verilmişti.
Sonuç: Nakledilen bazı bebekler uygun olmayan PGE ve oksijen tedavileri almıştır. Bu nedenle, sevk veya nakil ekibi üyeleri KKKH hakkında bilgi sahibi olmalıdır. Nakil işleminin cerrahi zamanlama üzerindeki etkisi anlamlı bulunmamıştır. Bununla birlikte, hastane dışında doğan grubun daha düşük STAT skorları göstermesine rağmen, her iki grupta da benzer ölüm oranları gözlenmiştir. Bu durum, intrauterin naklin deneyimli kardiyovasküler merkezlere yönlendirilmesinin önemine işaret edebilir.

Keywords

Kritik konjenital kalp hastalığı, yenidoğan, nakil

Ethical Statement

The study was approved by the Ethics Committee of the Medical Faculty at Çukurova University (Approval number 2022-125). Informed consent was obtained from legal guardians.

Impact of transport outcomes of outborn newborns with critical congenital heart disease on surgery time and mortality rates

Abstract

Purpose: Transport of neonates with critical congenital heart disease (CCHD) necessitates professional and experienced staff and, well-equipped facilities for both the procedure and post-operative care. In this study, we aimed to evaluate the effect of transport on operation time and survival in neonates with CCHD and determine the relationship between transport characteristics and clinical status.
Materials and Methods: A retrospective cross-sectional cohort study was conducted on all infants with CCHD who were transported to a university hospital between January 1, 2019 and December 31, 2019. Transport characteristics such as transport distance, accompanying healthcare provider, vital signs, oxygen saturation levels, prostaglandin E1 (PGE) use, and respiratory support were recorded. The effects of transport characteristics on surgery time, complications, and mortality were analyzed. The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) Score was used to analyze mortality-related risks for congenital heart disease. They were compared with inborn newborns with CCHD.
Results: A total of 55 patients with CCHD were evaluated. Thirty-one newborns (56.4%) were inborn (Inborn group), and 24 newborns (43.6%) were transferred from another center (Outborn group). There was no difference between the groups in terms of gender, gestational age, birth weight, pre-operative time, and hospital stay. Although the Outborn group had fewer STAT Score categories, there was no difference in the 30-day survival or mortality rates. In the Outborn group, five patients (20.8%) with duct-dependent CCHD were transported without PGE treatment and six duct-dependent (25%) patients received oxygen during transport inappropriately.
Conclusion: The administration of PGE and oxygen therapies to specific transported infants was inappropriate. Therefore, referral or transport team members should be familiar infants with CCHD. The impact of transport on surgical timing did not yield a significant effect. However, similar mortality rates were observed in both groups, despite the Outborn group demonstrating lower STAT scores. This may indicate the significance of referring intrauterine transportation to experienced cardiovascular centers.

Keywords

Critical congenital heart disease, Neonate, transport

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