Effects of pulmonary surfactant in treatment of acute lung injury after cardiac surgery in infants / 中华儿科杂志

<p><b>OBJECTIVE</b>Acute lung injury is a severe complication after cardiac surgery performed with cardiopulmonary bypass in infant patients. Pulmonary surfactant has been successfully used in treating neonatal respiratory distress syndrome for many years. This study focused on exploring the clinical efficacy of exogenous pulmonary surfactant in treating infant patients with acute lung injury after cardiac surgery with the use of extracorporeal circulation.</p><p><b>METHOD</b>Twenty-three infants with ventricular septal defect (VSD) were enrolled in the study. None of the patients needed oxygen treatment nor ventilation before heart surgery. VSD repair operation was done under cardiopulmonary bypass, and acute lung injury was found postoperatively. Ten infant patients in the treatment group were given pulmonary surfactant by tracheal instillation during mechanical ventilating postoperatively. Thirteen patients in control group were randomly selected in the same period in hospital, and acute lung injury was diagnosed without pulmonary surfactant treatment after cardiopulmonary bypass. Blood samples were obtained from all the patients, and blood gas analysis was performed every 6 hours. Demographics (body weigh, age, gender, VSD diameter) and clinical characteristics (CPB time, oxygenation index, mean airway pressure, pH and PCO2) of all the patients were collected, and statistical analysis was done to compare the data between treatment and control group.</p><p><b>RESULT</b>In the first 24 hours after heart surgery, compared with the control group, a more increased oxygenation index (from 89.36 ± 12.69 to 285 ± 16.51) was observed in treatment group, and it was from 93.71 ± 11.82 to 133 ± 19.62 in the control group. There was a significant difference in oxygenation index between the two groups (P < 0.05). At the same time, the MAP (from 17.5 ± 3.18 to 10.4 ± 3.37) of the patients in comparison with the control group (from 18.2 ± 2.63 to 13.8 ± 2.55), a more significantly decreased MAP was observed in the treatment group (P < 0.05). There was no significant difference in pH and PCO2 between the two groups. The ventilation time in cardiac care unit was shorter in treatment group (17.43 ± 9.12) h compared with the control group [(30.97 ± 14.85) h, P < 0.05]. ICU stay time of treatment group (3.90 ± 1.34) d was shorter than that of control group [(6.18 ± 1.90) d, P < 0.05].Two infants of the control group died, but none in treatment group died.</p><p><b>CONCLUSION</b>In this study, a satisfactory curative effect was observed for the treatment of acute lung injury with PS intratracheal instillation after heart surgery under cardiopulmonary bypass in infant patients. It can reduce the duration of mechanical ventilation and cardiac care unit stay and improve prognosis. In addition, this study was a pilot study and the limited sample size was probably the cause of insufficient statistical power. Further study of larger scale is needed.</p>

Incidence of congenital heart disease in Beijing, China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The incidence of congenital heart disease has been studied in developed countries for many years, but rarely in the mainland of China. Fetal echocardiographic screening for congenital heart disease was first performed in Beijing in the early 2000s, but the impact was not clear. The current study was undertaken to determine the incidence of congenital heart disease in Beijing, China and to estimate the impact of fetal echocardiography on the incidence of liveborn congenital heart disease.</p><p><b>METHODS</b>The study involved all infants with congenital heart disease among the 84 062 total births in Beijing during the period of January 1 and December 31, 2007. An echocardiographic examination was performed on every baby suspected to have congenital heart disease, prenatally or/and postnatally.</p><p><b>RESULTS</b>A total of 686 infants were shown to have congenital heart disease among 84 062 total births. The overall incidence was 8.2/1000 total births. Mothers of 128 of 151 babies diagnosed prenatally were chosen to terminate the pregnancy. Two of the 151 infants died in utero. A specific lesion was identified for each infant and the frequencies of lesions were determined for each class of infants (total births, stillbirths and live births). The incidence of congenital heart disease in stillbirths and live births was 168.8/1000 and 6.7/1000, respectively. The difference between the incidence of total birth and the incidence of live birth was statistically significant (P < 0.001).</p><p><b>CONCLUSIONS</b>The incidence of liveborn congenital heart disease in Beijing is within the range reported in developed countries. Fetal echocardiography reduce significantly the incidence of liveborn congenital heart disease.</p>