Critical heart disease in the neonate: presentation and outcome at a tertiary care center.
OBJECTIVE
To define the modes of presentation, incidence of major organ dysfunction, predictors of hospital mortality, and adverse outcomes in neonates with critical heart disease admitted to a tertiary care center.


METHODS
Retrospective chart review.


METHODS
A tertiary care pediatric cardiac intensive care unit and neonatal intensive care unit.


METHODS
The medical records for all neonates (< or = 30 days of age) with heart disease admitted to the cardiac intensive care unit or neonatal intensive care unit between October 1, 2002, and September 30, 2003, were reviewed.


METHODS
None.


RESULTS
A total of 190 neonates met inclusion criteria during this 1-yr period, of which 146 (77%) had at least one surgical procedure. Single ventricle heart disease was present in 42%. The most common mode of presentation was following a prenatal diagnosis (53%), followed by diagnosis in the newborn nursery (38%) and diagnosis after newborn hospital discharge (8%). The most common presenting findings in the newborn nursery were isolated murmur (38%) or cyanosis (32%), while circulatory collapse (38%) was the most common presentation after discharge. For the entire study cohort, 13% had a known genetic syndrome, 23% had a major noncardiac congenital anomaly, and 16% weighed < 2.5 kg. The hospital mortality for the entire cohort was 7.4%. Risk factors associated with an increased risk of hospital mortality included younger age at admission, higher number of cardiopulmonary bypass runs, and need for postoperative cardiopulmonary resuscitation. Total hospital length of stay was > 1 month in 17% of neonates.


CONCLUSIONS
In patients with complex congenital heart disease, including nearly half with single ventricle heart disease, neonatal hospital mortality was 7%. These patients have a high frequency of multiple congenital anomalies, genetic syndromes, low birth weight, and prolonged length of stay.
Dorfman
Aaron T
AT
Department of Pediatrics, Division of Cardiology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 19104, USA.
Marino
Bradley S
BS
Wernovsky
Gil
G
Tabbutt
Sarah
S
Ravishankar
Chitra
C
Godinez
Rodolfo I
RI
Priestley
Margaret
M
Dodds
Kathryn M
KM
Rychik
Jack
J
Gruber
Peter J
PJ
Gaynor
J William
JW
Levy
Richard J
RJ
Nicolson
Susan C
SC
Montenegro
Lisa M
LM
Spray
Thomas L
TL
Dominguez
Troy E
TE
D000208:Acute Disease; D016638:Critical Illness; D005260:Female; D006331:Heart Diseases / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D015143:Philadelphia / Q000453:epidemiology; D012121:Respiration, Artificial; D012189:Retrospective Studies