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Selected Publication:
Kovalevska, K.
Epidemiology and risk factors of unfavorable course of congenital heart defects in newborns
Studium für die Gleichwertigkeit; Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2017. pp. 55
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- Authors Med Uni Graz:
- Advisor:
- Breschan Christian
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- Abstract:
- Introduction. Congenital heart disease (CHD) remains the most frequent of all congenital anomalies. Due to their high prevalence and mortality rate CHD is considered as an important public health issue all over the world: up to 22% of infants die in the first week of life, and 30-80% - in the first year of life. If CHD is early diagnosed, half of these children can be saved with the help of timely surgical intervention. Materials and methods. Annual statistical reports were analyzed in details for the determination of morbidity and mortality rates among the infants suffering from the CHD in Odessa region for the period of 2007-2011. A retrospective analysis of 81 newborn case histories with CHD (1st group) and 100 newborns without CHD (2nd group) was performed. To identify the unfavorable course predictors, the 1st group was divided into 2 subgroups: 1.1 - unfavorable course (death or an indication for immediate cardiac surgery), 1.2 - favorable course (presence or absence of clinical signs, but no indications for urgent cardiac surgery) . Statistical analyses were performed using STATISTICA 5, on-line calculator SISA CLARA. Results. During the last 5 years, in the Odessa region CHD alone accounts for almost about 9% of neonatal morbidity and occupies the second place amidst the overall Congenital Anomalies. Isolated CHD is responsible for 7-8% of all neonatal mortality. The absolute mortality rate from CHD in last 5 years decreased from 0,56 ‰ to 0,45 ‰; proportional mortality rate is 67%. Statistically significant risk factors for CHD were diagnosed:TORCH-infection (OR = 2.83, 95% CI 4.1 - 16.1), the CHD in the mother (OR = 5.9, 95% CI 0.6 - 47, 03), and with a Bad Obstetric History (BOH) (OR = 1.4, 95% CI 0.4 - 2.5). Unfavorable course predictors of CHD during the neonatal period were prematurity, ARI in the first trimester of pregnancy, the presence of comorbid conditions, hypoxic-ischemic encephalopathy. Conclusion. Optimization of early diagnosis and management of CHD could play a significant role in the reduction of neonatal mortality rate. Proper identification of the risk factors of CHD is a definite indication for performing an early neonatal screening: pulse oxymetry and echocardiography (if available) before the discharge of the child from the the health care facility.Unfavorable course predictors can also help to determine the optimal treatment measures of CHD during the neonatal period.