title: Critical heart disease in the neonate: presentation and outcome at a tertiary care center.
abstract: 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.
authors.affiliation: Department of Pediatrics, Division of Cardiology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 19104, USA.
authors.forename: Aaron T
authors.initials: AT
authors.lastname: Dorfman
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Marino
authors.forename: Gil
authors.initials: G
authors.lastname: Wernovsky
authors.forename: Sarah
authors.initials: S
authors.lastname: Tabbutt
authors.forename: Chitra
authors.initials: C
authors.lastname: Ravishankar
authors.forename: Rodolfo I
authors.initials: RI
authors.lastname: Godinez
authors.forename: Margaret
authors.initials: M
authors.lastname: Priestley
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Dodds
authors.forename: Jack
authors.initials: J
authors.lastname: Rychik
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Gruber
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Levy
authors.forename: Susan C
authors.initials: SC
authors.lastname: Nicolson
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Montenegro
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Spray
authors.forename: Troy E
authors.initials: TE
authors.lastname: Dominguez
mesh_terms: 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