Congenital heart disease: clinical characterization in newborns from a referral hospital, Manaus, Amazonas, Brazil
Palavras-chave:
Heart disease;, Congenital disease, Cyanosis, Newborn, Manaus.Resumo
In Brazil, the impact of congenital heart disease (CHD) remains obscured by limited data, especially in the northern region. For this reason, our study seeks to uncover the prevalence and clinical variations of CHD in Manaus, Amazonas. This study followed a cross-sectional model performed in 110 newborns with CHD diagnosed between March 2022 to April 2023. Complex CHD was present in about 80% of the newborns, which increased the risk of requiring multiple surgical interventions. We found and characterized 19 CHD phenotypes, with a higher prevalence of complex CHD cases. We documented 12 fatalities, mostly attributed to septic and cardiogenic shock related to complex CHD with high levels of urea, creatinine, AST, ALT, CRP, GGT, NT-proBNP and acidosis (p<0.001). Our findings suggest a close relationship between CHD and a systemic impact with chronic/acute kidney failure and hepatopathies. Inadequate data from the information system on live births (SINASC) results in underreporting and increased CHD mortality rates, emphasizing the urgency for new strategies to enhance case identification and improve early diagnosis of critical CHD with important systemic repercussions.
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ALVES, R. M. C.; CABEÇA, A. L. L. de C. .; ALVES, M. C. .; SIMÕES, M. C. .; et al. Epidemiological study of congenital heart disease in the State of Pará, Amazon, Brazil. Research, Society and Development, [S. l.], v. 11, n. 13, p. e289111335193, 2022.
ARAGÃO, J. A., MENDONÇA, M. P., SILVA, M. S., et al. (2013). O Perfil Epidemiológico dos Pacientes com Cardiopatias Congênitas Submetidos à Cirurgia no Hospital do Coração. Revista Brasileira De Ciências Da Saúde, 17(3), 263–268. Recuperado de https://periodicos.ufpb.br/ojs/index.php/rbcs/article/view/13221
BAERWOLF C, KAEMMERER H, KILNER P, et al. Task Force on the Management of Grown-up Congenital Heart Disease of the European Society of Cardiology (ESC); Association for European Paediatric Cardiology (AEPC); ESC Committee for Practice Guidelines (CPG). ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J. 2010 Dec;31(23):2915-57.
BELO WA, OSELAME GB, NEVES EB. Perfil clínico-hospitalar de crianças com cardiopatia congênita. Cad saúde colet [Internet]. 2016Apr;24(2):216–20.
BERTOLETTI J, MARX GC, HATTGE JÚNIOR SP, PELLANDA LC. Quality of life and congenital heart disease in childhood and adolescence. Arq Bras Cardiol. 2014 Feb;102(2):192-8
BRASIL. Ministério da Saúde. Secretaria de Ciência, Tecnologia, e Insumos Estratégicos. Departamento de Ciência e Tecnologia. BRASIL. Síntese de evidências para políticas de saúde: diagnóstico precoce de cardiopatias congênitas / Evidence brief for policy: early diagnosis of congenital heart disease. Brasília; Ministério da Saúde; 2017. 42 p. ilus, tab
BRISSAUD O, BOTTE A, CAMBONIE G, DAUGER S, et al. Experts' recommendations for the management of cardiogenic shock in children. Ann Intensive Care. 2016 Dec;6(1):14.
CHAN KH, SANATANI S, POTTS JE, HARRIS KC. The relative incidence of cardiogenic and septic shock in neonates. Paediatr Child Health. 2019 Jun 24;25(6):372-377.
MATTOS SS, REGIS CT, MOURATO FA, et al. Busca ativa por cardiopatias congênitas é factível? Experiência em oito cidades Brasileiras. Int J Cardiovasc Sci [Internet]. 2015;28(2):95-100. Available from: http://www.onlineijcs.org/sumario/28/pdf/v28n2a03.pd
DENG X, JIN B, LI S, et al. Guideline implementation and early risk assessment in pulmonary arterial hypertension associated with congenital heart disease: A retrospective cohort study. Clin Respir J. 2019 Nov;13(11):693-699.
DESAI K, RABINOWITZ EJ, EPSTEIN S. Physiologic diagnosis of congenital heart disease in cyanotic neonates. Curr Opin Pediatr. 2019 Apr;31(2):274-283.
DOLGNER SJ, BUBER J, STOUT KK, STEINBERG ZL. What Every Cardiologist Should Know About the 2018 Updated Adult Congenital Cardiology Guidelines. Curr Cardiol Rep. 2020 Feb 19;22(4):24.
EL SAYEGH S, EPHREM G, WISH JB, et al. Kidney disease and congenital heart disease: Partnership for life. Front Physiol. 2022 Aug 19;13:970389.
FANG NW, CHEN YC, OU SH, et al, Chiou YH. Incidence and risk factors for chronic kidney disease in patients with congenital heart disease. Pediatr Nephrol. 2021 Nov;36(11):3749-3756.
FEIL AC, KURTZ T, ABREU P DE O, et al. FEIL, Angélica Cristine et al. Sepse tardia em Unidade de Tratamento Intensivo Neonatal. Revista de Epidemiologia e Controle de Infecção, Santa Cruz do Sul, v. 8, n. 4, out. 2018. ISSN 2238-3360. Disponível em: <https://online.unisc.br/seer/index.php/epidemiologia/article/view/11581>.
FERNANDES, BA., MAHER, KO., & DESHPANDE, SR (2016). Cardiac biomarkers in pediatric heart disease: A state of art review. World journal of cardiology, 8(12), 719–727
HOFFMAN, JI., & KAPLAN, S (2002). The incidence of congenital heart disease. Journal of the American College of Cardiology, 39(12), 1890–1900
JESUS, VSDE., NASCIMENTO, AM., MIRANDA, et al. (2018). Waiting for Cardiac Procedure in Congenital Heart Disease: Portrait of a Hospital in the Amazonian Region. International Journal of Cardiovascular Sciences, 31(4), 374–382
KEHL, T., BIERMANN, D., BRIEM-RICHTER, et al (2021). Impact of hepatopathy in pediatric patients after surgery for complex congenital heart disease. PloS one, 16(3), e0248776
KHALIL, M., JUX, C., RUEBLINGER, L., et al. (2019). Acute therapy of newborns with critical congenital heart disease. Translational pediatrics, 8(2), 114–126
KHATAMI, M., MAZIDI, M., TAHER, S., et al. (2018). Novel Point Mutations in the NKX2.5 Gene in Pediatric Patients with Non-Familial Congenital Heart Disease. Medicina (Kaunas, Lithuania), 54(3), 46
KHUONG, JN., WILSON, TG., IYENGAR, AJ., & D'UDEKEM, Y (2021). Acute and Chronic Kidney Disease Following Congenital Heart Surgery: A Review. The Annals of thoracic surgery, 112(5), 1698–1706
KRISHNA, MR., & KUMAR, RK (2020). Diagnosis and Management of Critical Congenital Heart Diseases in the Newborn. Indian journal of pediatrics, 87(5), 365–371
LEITE, DDE L., MIZIARA, H., & VELOSO, M. (2010). Malformações cardíacas congênitas em necropsias pediátricas: características, associações e prevalência. Arquivos Brasileiros De Cardiologia, 94(3), 294–299
LIU, Y., CHEN, S., ZÜHLKE, L., et al. (2019). Global birth prevalence of congenital heart defects 1970-2017: updated systematic review and meta-analysis of 260 studies. International journal of epidemiology, 48(2), 455–463
SOARES, AM. (2018). Mortality for Critical Congenital Heart Diseases and Associated Risk Factors in NewbornsA Cohort Study. Arquivos Brasileiros De Cardiologia, 111(5), 674–675
MA, XJ., & HUANG, GY (2018). Current status of screening, diagnosis, and treatment of neonatal congenital heart disease in China. World journal of pediatrics: WJP, 14(4), 313–314
MAHMOUD, H., NICOLESCU, AM., FILIP, C., et al (2019). Complex atrial septal defect closure in children. Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie, 60(1), 49–57
MARINO, BS., LIPKIN, PH., NEWBURGER, JW., et al., American Heart Association Congenital Heart Defects Committee, Council on Cardiovascular Disease in the Young, Council on Cardiovascular Nursing, and Stroke Council. Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management: a scientific statement from the American Heart Association. Circulation. 2012 Aug 28;126(9):1143-72.
MCPHILLIPS, L., KHOLWADWALA, D., SISON, CP., et al. (2019). A Novel Brain Injury Biomarker Correlates with Cyanosis in Infants with Congenital Heart Disease. Pediatric cardiology, 40(3), 546–553
PIERPONT ME, BRUECKNER M, CHUNG WK, et al. American Heart Association Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; and Council on Genomic and Precision MedicineGenetic Basis for Congenital Heart Disease: Revisited: A Scientific Statement from the American Heart Association. Circulation 2018 Nov 20;138(21):e653-e711
SALIM, TR., ANDRADE, TM., KLEIN, CH., & OLIVEIRA, GMM (2020). Inequalities in Mortality Rates from Malformations of Circulatory System Between Brazilian Macroregions in Individuals Younger Than 20 Years. Arquivos brasileiros de cardiologia, 115(6), 1164–1173
SHABANA, NA., SHAHID, SU., & IRFAN, U (2020). Genetic Contribution to Congenital Heart Disease (CHD). Pediatric cardiology, 41(1), 12–23
SOARES AM (2020). Mortality in Congenital Heart Disease in Brazil - What do we Know? Mortalidade em Doenças Cardíacas Congênitas no Brasil - o que sabemos? Arquivos brasileiros de cardiologia, 115(6), 1174–1175
SOLA, A., RODRÍGUEZ, S., YOUNG, A., et al (2020). CCHD Screening Implementation Efforts in Latin American Countries by the Ibero American Society of Neonatology (SIBEN). International journal of neonatal screening, 6(1), 21
SPICER, DE., HSU, HH., CO-VU, J., et al (2014). Ventricular septal defect. Orphanet J Rare Dis. 2014 Dec 19;9:144
SUN R, LIU M, LU L, et al . Congenital Heart Disease: Causes, Diagnosis, Symptoms, and Treatments. Cell Biochem Biophys. 2015 Jul;72(3):857-60.
TRIPOSKIADIS F, XANTHOPOULOS A, PARISSIS J, et al. Pathogenesis of chronic heart failure: cardiovascular aging, risk factors, comorbidities, and disease modifiers. Heart Fail Rev. 2022 Jan;27(1):337-344.
VAN DEN EYNDE, J., DELPIRE, B., JACQUEMYN, X. et al. Risk factors for acute kidney injury after pediatric cardiac surgery: a meta-analysis. Pediatr Nephrol 37, 509–519 (2022).
VAN DER LINDE D, KONINGS EE, SLAGEr MA, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol. 2011 Nov 15;58(21):2241-7.
XIE H, HUO Y, CHEN Q, HOU X. Application of B-Type Natriuretic Peptide in Neonatal Diseases. Front Pediatr. 2021 Dec 7;9:767173
