1 聖隷浜松病院小児循環器科Division of Pediatric Cardiology, Seirei Hamamatsu General Hospital ◇ Hamamatsu, Japan
2 聖隷浜松病院心臓血管外科Department of Cardiovascular Surgery, Seirei Hamamatsu General Hospital ◇ Hamamatsu, Japan
背景：極低出生体重児（VLBWI）の救命率は著しく向上したが，先天性心疾患（CHD）を伴うVLBWIの検討は少ない．
目的：CHD合併のVLBWIの概要，中期予後の明らかにすること．
方法：2000～2006年に当院NICUに入院した456例のVLBWIを対象とした．CHDの診断は臨床症状含め全例心エコー検査で行い，手術，剖検例はその診断に従った．対象をCHD群，非CHD群にわけ，在胎週数，出生体重，染色体異常・奇形症候群，心外奇形合併率，また壊死性腸炎，慢性肺疾患などの罹病率と死亡率を両群間で比較した．CHD群では疾患別内訳，治療内容を検討した．
結果：CHD群は26例で，心疾患の発生は出生1,000に対して57人だった．染色体異常・奇形症候群，心外奇形合併はCHD群でそれぞれ38.5％，34.6％，非CHD群では1.9％，7.2％に見られ，非CHD群に比較しCHD群で有意に高率だった（p＜0.05）．疾患の内訳は心室中隔欠損症が最も多く（10例，38.5％），次いで大動脈縮窄症（3例，11.5％），房室中隔欠損，肺動脈狭窄，大動脈弁狭窄（各2例，7.7％）などであった．心臓手術は10例（38.5％）で施行され，約60％のVLBWIが循環作動薬を含めた内科的治療を必要とした．壊死性腸炎，頭蓋内出血，慢性肺疾患の罹病率，NICU入院期間は両群間で差はなかったが，CHD群の病院死亡率は26.9％，5年生存率は65.4％で，非CHD群（11.9％，86.2％）と比較して病院死亡率が高く，生存率は低かった（p＜0.05）．
結語：一般のCHDの頻度に比較してVLBWIにおけるCHD頻度は高い可能性があり，早期から治療を要する重症なCHDが多い．またCHD症例は染色体・奇形症候群，また消化管奇形などの心外奇形の合併が多く，CHDを伴わないVLBWIに比較して予後は悪い．
Objectives: Few studies have examined congenital heart disease (CHD) in very low-birth-weight (VLBW) infants. This study was conducted to characterize the incidence, distribution, and midterm outcomes of CHD in VLBW infants at our hospital.
Methods: We reviewed case data obtained from 456 VLBW infants at our neonatal intensive care unit (NICU) between January 2000 and December 2006. Cardiac diagnoses were confirmed using echocardiography, surgery, and autopsy. Cases of arrhythmia with a normally structured heart, isolated patent duct arteriosus, and interatrial defect ＜5.5 mm were excluded.
Results: CHD was detected In 26 infants (5.7％). The VLBW infants with CHD showed a significantly higher rate of genetic syndromes and extracardiac malformations compared with non-CHD infants (CHD group, 38.5％ and 34.6％; non-CHD group, 1.9％ and 7.2％, respectively). The most common lesions were ventricular septal defect [n＝10, (38.5％)], coarctation of the aorta [n＝3, (11.5％)], atrioventricular septal defect [n＝2, (7.7％)], pulmonary stenosis [n＝2, (7.7％)], and aortic valve stenosis [n＝2, (7.7％)]. Ten infants with CHD required surgical treatment, and 15 infants (57.7％) needed medical treatment, including inotropic agents. The relative incidence of necrotizing enterocolitis, chronic lung disease, and intracranial hemorrhage was similar in CHD and non-CHD infants. The mortality rate of CHD infants in our NICU was significantly higher than that of non-CHD infants (26.9％ vs. 11.9％). Moreover, 5-year survival was significantly lower for CHD infants (65.4％) than for non-CHD infants (86.2％).
Conclusions: CHD occurs more frequently in VLBW infants than in the general Japanese live-born population. VLBW infants with CHD have a higher incidence of severe CHD and genetic and extracardiac malformations and higher mortality than non-CHD infants.
Key words: very low birth weight infants; congenital heart disease; mortality; morbidity
© 2016 特定非営利活動法人日本小児循環器学会© 2016 Japanese Society of Pediatric Cardiology and Cardiac Surgery
This page was created on 2016-03-07T15:43:53.101+09:00
This page was last modified on 2016-04-12T11:31:59.193+09:00
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