Academic Journal
Factors influencing the choice-of-care pathway and survival in the fetus with hypoplastic left heart syndrome in New Zealand: a population-based cohort study.
| العنوان: | Factors influencing the choice-of-care pathway and survival in the fetus with hypoplastic left heart syndrome in New Zealand: a population-based cohort study. |
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| المؤلفون: | Soszyn, Natalie, Cloete, Elza, Sadler, Lynn, de Laat, Monique WM, Crengle, Sue, Bloomfield, Frank, Finucane, Kirsten, Gentles, Thomas L |
| بيانات النشر: | BMJ |
| سنة النشر: | 2023 |
| المجموعة: | University of Auckland Research Repository - ResearchSpace |
| مصطلحات موضوعية: | congenital heart disease, fetal medicine, paediatric cardiac surgery, paediatric cardiology, 1103 Clinical Sciences, 1117 Public Health and Health Services, 1199 Other Medical and Health Sciences |
| جغرافية الموضوع: | England |
| الوصف: | To better understand the relative influence of fetal and maternal factors in determining the choice-of-care pathway (CCP) and outcome in the fetus with hypoplastic left heart syndrome (HLHS). A retrospective, population-based study of fetuses with HLHS from a national dataset with near-complete case ascertainment from 20 weeks' gestation. Fetal cardiac and non-cardiac factors were recorded from the patient record and maternal factors from the national maternity dataset. The primary endpoint was a prenatal decision for active treatment after birth (intention-to-treat). Factors associated with a delayed diagnosis (≥24 weeks' gestation) were also reviewed. Secondary endpoints included proceeding to surgical treatment, and 30-day postoperative mortality in liveborns with an intention-to-treat. New Zealand population-wide. Fetuses with a prenatal diagnosis of HLHS between 2006 and 2015. Of 105 fetuses, the CCP was intention-to-treat in 43 (41%), and pregnancy termination or comfort care in 62 (59%). Factors associated with intention-to-treat by multivariable analysis included a delay in diagnosis (OR: 7.8, 95% CI: 3.0 to 20.6, p<0.001) and domicile in the maternal fetal medicine (MFM) region with the most widely dispersed population (OR: 5.3, 95% CI: 1.4 to 20.3, p=0.02). Delay in diagnosis was associated with Māori maternal ethnicity compared with European (OR: 12.9, 95% CI: 3.1 to 54, p<0.001) and greater distance from the MFM centre (OR: 3.1, 95% CI: 1.2 to 8.2, p=0.02). In those with a prenatal intention-to-treat, a decision not to proceed to surgery was associated with maternal ethnicity other than European (p=0.005) and the presence of major non-cardiac anomalies (p=0.01). Thirty-day postoperative mortality occurred in 5/32 (16%) and was more frequent when there were major non-cardiac anomalies (p=0.02). Factors associated with the prenatal CCP relate to healthcare access. Anatomic characteristics impact treatment decisions after birth and early postoperative mortality. The association of ethnicity with ... |
| نوع الوثيقة: | article in journal/newspaper |
| وصف الملف: | Electronic; application/pdf |
| اللغة: | English |
| تدمد: | 2044-6055 |
| Relation: | BMJ open; (2023). BMJ Open, 13(4), e069848-.; https://hdl.handle.net/2292/64098; 37055204 (pubmed); bmjopen-2022-069848 |
| DOI: | 10.1136/bmjopen-2022-069848 |
| الاتاحة: | https://hdl.handle.net/2292/64098 https://doi.org/10.1136/bmjopen-2022-069848 |
| Rights: | Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. ; https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm ; http://creativecommons.org/licenses/by-nc/4.0/ ; Copyright: The authors ; http://purl.org/eprint/accessRights/OpenAccess |
| رقم الانضمام: | edsbas.A3B335BE |
| قاعدة البيانات: | BASE |
Full Text Finder | تدمد: | 20446055 |
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| DOI: | 10.1136/bmjopen-2022-069848 |