Comprehensive management strategy for critical newborns with transposition of great arteries
10.3760/cma.j.issn.2095-428X.2013.01.019
- VernacularTitle:完全性大动脉转位重症新生儿临床综合救治策略
- Author:
Xiao-Yang HONG
1
;
Geng-Xu ZHOU
;
Xuan XU
;
Yu-Hang LIU
;
Hui WANG
;
Ying-Yue LIU
;
Zhi-Chun FENG
Author Information
1. 100007 北京军区总医院附属八一儿童医院PICU;南方医科大学八一临床医学院附属八一儿童医院PICU
- Keywords:
Transposition of great arteries;
Infant,newborn;
Neonatal intensive care unit;
Arterial switch operation
- From:
Chinese Journal of Applied Clinical Pediatrics
2013;28(1):65-68
- CountryChina
- Language:Chinese
-
Abstract:
Objective To summarize the clinical experience of comprehensive management of critical newborns with transposition of great arteries (TGA) by neonatologists and cardiac surgeons.Methods Seventeen critical newborns with TGA rescued by combined efforts of neonatologists and pediatric cardiac surgeons from Oct.2010 to Oct.2012were retrospectively analyzed.Results Of the 17 newborns(14 cases were male,3 cases were female),9 cases were TGA with ventricular septal defect(TGA/VSD),8 cases TGA with intact ventricular septal defect (TGA/IVS).The babies aged from 1-45 days,weighed from 2.7-4.6 kg at operation.Of the 9 cases TGA/VSD babies,3 cases were treated with prostaglandins E (PGE) for hypoxemia correction and selective operation opportunity ;2 cases underwent emergency arterial switch operation (ASO) for severe cardiac shock.All of the 8 cases TGA/IVS babies received PGE treatment preoperatively for life threatening hypoxemia,and 4 cases of them underwent emergency ASO.There were 12 cases delayed sternal closure and 5 cases of them were emergency babies.Peritoneal dialysis was employed for 6 cases and extracorporeal membrane oxygenation (ECMO) for l case.There were 6 cases with postoperative incision infection,including 5 emergencies.Thirteen newborns survived and 4 cases died at hospital:one case complicated with postoperative septicemia and severe mediastinitis which leaded to pericardium patch rupture and fatal pulmonary arterial hemorrhage;one case with abnormal inferior vena cava connection and severe low cardiac output syndrome;one case with disseminated intravascular coagulation (DIC) due to septicemia and severe mediastinitis postoperatively,one case with abnormal coronary artery during surgery and difficult coronary artery transplantation and insufficient blood supply after aorta was open.Conclusions Correcting hypoxemia and stabilizing the severe babies are critical in NICU to avoid emergency surgery.Emergent ASO is the optimized medical therapy for those with persistent severe hypoxemia and heart failure.
