越南国立儿童医院先天性膈疝新生儿的临床特点和预后:一项回顾性观察研究

IF 2 3区 医学 Q2 PEDIATRICS
Duong Anh Dang, Thuan Van Nguyen, Dung Thi Thu Nguyen, Dung Thi Pham, Phuong Thi Ha Nguyen, Thuong Duc Nguyen, Tuan Anh Pham, Dung Thi Thuy Le, Mung Thi Ngo, My Ha Nguyen, Hien Hai Dao, Son Hong Pham, Mai Thi Thanh Nguyen, Ha Thi Thu Tran, Son Ngoc Do, Ngoc Huy Nguyen, Chinh Quoc Luong
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引用次数: 0

摘要

背景:先天性膈疝(CDH)具有很高的死亡率,特别是在低收入和中等收入国家。本研究旨在调查越南CDH新生儿的死亡率及其相关因素。方法:这项回顾性观察性研究纳入了2021年11月至2023年9月期间在越南一家中心儿童医院住院的CDH新生儿。我们收集了新生儿的特征、管理、并发症和结局的数据,并将这些数据在幸存者和非幸存者之间进行比较。我们还采用逻辑回归分析来确定与住院死亡率相关的因素。结果:74例新生儿CDH中,男性占64.9%(48/74)。住院死亡率为50.0%(37/74)。出生时中位胎龄为38周(四分位数差[IQR]: 38-39),入院时中位年龄为5.2 h (IQR: 3.0-15.8)。所有新生儿都是从以前的不同医院转介的,83.8%(62/74)的新生儿需要产后立即插管。新生儿表现为危重状态,入院时平均肺动脉收缩压(PASP)为51.7 mmHg(标准差:18.3),6 h时平均氧合指数为13.3 (IQR: 6.8-28.2)。手术重症监护病房期间血管活性肌力评分(VIS)的中位峰值为35.0 (IQR: 15.0-80.0)。52.7%(39/74)的病例采用高频振荡通气作为初始通气方式。支持治疗包括血管加压药物(84.9%;62/73)、肌力药物(29.6%;21/71)、吸入一氧化氮(13.5%;10/74)、伊洛美定(29.7%;19/64)和体外膜氧合(6.8%;5/74)。70.3%(52/74)的新生儿接受手术修复。多变量logistic回归分析发现,较高的VIS峰(调整优势比[AOR]: 1.061; 95%可信区间[CI]: 1.011-1.113; p = 0.017)和较高的入院PASP (AOR: 1.140; 95% CI: 1.041-1.247; p = 0.005)是住院死亡率的独立预测因子。结论:在越南一家中心儿童医院收治的CDH新生儿队列中,观察到较高的医院死亡率。研究结果表明,获得新生儿重症监护和手术修复的机会有限可能会影响结果,需要在类似资源有限的环境中进一步评估以改进护理策略。试验注册:不适用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Clinical characteristics and outcomes of neonates with congenital diaphragmatic hernia at the Vietnam National Children's Hospital: a retrospective observational study.

Clinical characteristics and outcomes of neonates with congenital diaphragmatic hernia at the Vietnam National Children's Hospital: a retrospective observational study.

Background: Congenital diaphragmatic hernia (CDH) has a high mortality rate, particularly in low- and middle-income countries. This study aimed to investigate mortality rates and associated factors in CDH neonates in Vietnam.

Methods: This retrospective observational study included CDH neonates admitted to a central children's hospital in Vietnam between November 2021 and September 2023. We collected data on neonates' characteristics, management, complications, and outcomes, comparing these data between survivors and non-survivors. We also employed logistic regression analysis to identify factors associated with hospital mortality.

Results: Of 74 neonates with CDH, 64.9% (48/74) were male. The hospital mortality rate was 50.0% (37/74). The median gestational age at birth was 38 weeks (interquartile range [IQR]: 38-39), and the median age at admission was 5.2 h (IQR: 3.0-15.8). All neonates were referred from various prior hospitals, with 83.8% (62/74) requiring immediate postnatal intubation. The neonates presented in critical condition, as reflected by a median pre- and post-ductal SpO2 difference of 2.5% (IQR: 1.0-10.0), a mean pulmonary artery systolic pressure (PASP) of 51.7 mmHg (standard deviation: 18.3) on admission, and a median Oxygenation Index at 6 h of life of 13.3 (IQR: 6.8-28.2). The median peak Vasoactive Inotropic Score (VIS) during surgical intensive care unit stay was 35.0 (IQR: 15.0-80.0). High-frequency oscillatory ventilation was used as the initial ventilatory mode in 52.7% (39/74) of cases. Supportive therapies included vasopressors (84.9%; 62/73), inotropic agents (29.6%; 21/71), inhaled nitric oxide (13.5%; 10/74), Ilomedin (29.7%; 19/64), and extracorporeal membrane oxygenation (6.8%; 5/74). Surgical repair was performed in 70.3% (52/74) of neonates. Multivariable logistic regression analysis identified higher peak VIS (adjusted odds ratio [AOR]: 1.061; 95% confidence interval [CI]: 1.011-1.113; p = 0.017) and elevated admission PASP (AOR: 1.140; 95% CI: 1.041-1.247; p = 0.005) as independent predictors of hospital mortality.

Conclusions: In this selected cohort of CDH neonates admitted to a central children's hospital in Vietnam, a high hospital mortality rate was observed. The findings suggest that limited access to neonatal intensive care and surgical repair may have influenced outcomes, warranting further evaluation in similar resource-limited settings to improve care strategies.

Trial registration: Not applicable.

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来源期刊
BMC Pediatrics
BMC Pediatrics PEDIATRICS-
CiteScore
3.70
自引率
4.20%
发文量
683
审稿时长
3-8 weeks
期刊介绍: BMC Pediatrics is an open access journal publishing peer-reviewed research articles in all aspects of health care in neonates, children and adolescents, as well as related molecular genetics, pathophysiology, and epidemiology.
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