Open Access

ARTICLE

Prevalence and Spectrum of Complex Congenital Heart Disease in the Neonatal Intensive Care Unit at High Altitude in China

by Jingjing Li¹, Xiaorong Wang², Yuan Liu³, Guodong Zhao³, Ting Dai³, Hong Chen³, Haiyan Liao⁴, Haiying Qi^3,#,*, Jia Li^5,6,7,#,*

1 Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing, China
2 Department of Neonatology, Women and Children’s Hospital of Qinghai Province, Xining, China
3 Department of Echocardiography, Women and Children’s Hospital of Qinghai Province, Xining, China
4 Intensive Care Unit, Capital Institute of Pediatrics, Beijing, China
5 Clinical Physiology Laboratory, Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
6 Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
7 Clinical Physiology Laboratory, Institute of Pediatrics, Beijing, China

* Corresponding Authors: Jia Li. Email: ; Haiying Qi. Email:

^# The two authors had equal contribution

Congenital Heart Disease 2021, 16(1), 45-52. https://doi.org/10.32604/CHD.2021.013459

Received 07 August 2020; Accepted 09 October 2020; Issue published 23 December 2020

Abstract

Background: Previous studies from high altitudes have reported significantly higher prevalence of congenital heart disease (CHD), consisting almost solely of simple CHD. Little is known about the occurrence of complex CHD. Neonates with complex CHD are likely admitted to NICU. We examined the prevalence and spectrum of complex CHD in NICU in order to depict a truer picture of CHD at high altitude. Methods: We reviewed charts of 4,214 neonates admitted to NICU in Qinghai province (average altitude 3,000 m). Echocardiography was performed in 1,943 babies when CHD was suspected based on clinical examinations. Results: CHD was diagnosed in 1,093 (56.3% of echoed babies). Mild CHD in 96.8% (1058 babies). Moderate CHD in 0.8% (9) included 1 (0.1%) large secundum atrial septal defect, 3 (0.3%) moderate pulmonary stenosis, 2 (0.2%) aortic stenosis and 3 (0.3%) partial anomalous pulmonary venous connection. Severe CHD in 2.4% (26) included 6 (0.5%) complete atrioventricular septal defect, 5 (0.5%) complete transposition of the great arteries, 5 (0.5%) hypoplastic right heart, 3 (0.3%) hypoplastic left heart, 3 (0.3%) double outlet right ventricle, 3 (0.3%) tetralogy of Fallot, 2 (0.2%) truncus arteriosus, 2 (0.2%) total anomalous pulmonary venous connection, 2 (0.2%) severe aortic stenosis, 2 (0.2%) interrupted aortic arch and 2 (0.2%) severe pulmonary stenosis and 1 (0.1%) single-ventricle abnormality. At two-years follow-up in 737 (67.4%) patients, 18 (90%) with severe CHD and 38 (5.3%) with mild and moderate CHD died, and 15 underwent cardiac surgery with 1 early death. Conclusions: At high altitude, a wide spectrum of CHD exists, with many heretofore unreported complex CHD. There is urgent need for routine echocardiography and early interventions in newborns particularly in NICU.

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