Clinical outcomes of the neonates with critical pulmonary stenosis: intrauterine versus postnatal transport

Abstract

Background: Pulmonary stenosis (PS) is one rare congenital heart disease (CHD) featuring obstruction of right ventricular outflow tract. Critical pulmonary stenosis (CPS) is neonatal PS having cyanosis and evidence of patent ductus arteriosus (PDA) dependency. There is limited data on the clinical outcomes of CPS with different modes of transportation. This study aimed to investigate clinical features and outcomes of CPS through the intrauterine transport (IT) and postnatal transport (PT).

Methods: Single-center retrospective research was performed. Neonates with CPS were grouped into the IT group and PT group. Clinical characteristics and outcomes of the neonates were compared between the two groups.

Results: Totally 110 neonates with PS were included in this study, 77 with CPS and 33 with non-CPS. In the infants with CPS, there were 53 and 24 in the IT and PT group respectively. Echocardiography showed that transvalvular pulmonary gradient (TVG) stayed lower in the IT group than that in the PT group {77.0 [interquartile range (IQR), 60.5-91.5] vs. 92.0 (IQR, 73.3-125.0) mmHg, P=0.006}. Levels of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) and troponin I also remained lower in the IT group than those in the PT group [2,256 (IQR, 1,054-4,527) vs. 3,708 (IQR, 2,138-6,789) pg/mL, P=0.02; 0.020 (IQR, 0.011-0.034) vs. 0.042 (IQR, 0.027-0.072) ng/mL, P<0.001, respectively]. All infants with CPS received percutaneous balloon pulmonary valvuloplasty (PBPV) therapy in neonatal period and were discharged from the hospital. Length of hospital stay remained shorter in the IT group than that in the PT group [13.0 (IQR, 11.0-15.0) vs. 15.5 (IQR, 10.8-22.8) days, P=0.03].

Conclusions: IT and early management after birth could effectively reduce the severity of CPS before PBPV treatment and shorten the length of hospital stay among neonates suffering from CPS.

Keywords: Critical pulmonary stenosis (CPS); intrauterine transport (IT); newborn; percutaneous balloon pulmonary valvuloplasty (PBPV).

Figure 1

Patient enrollment flowchart. PS, pulmonary stenosis; PA, pulmonary atresia; CHD, congenital heart diseases; CPS, critical pulmonary stenosis; IT, intrauterine transport; PT, postnatal transport.

Figure 2

PAVmax, TVG, NT-proBNP, troponin I in neonates with PS between the IT group and PT group. *, P<0.05; **, P<0.01; ns, not significant. PAVmax, pulmonary artery velocity maximum; TVG, transvalvular pulmonary gradient; NT-proBNP, N-terminal pro-brain natriuretic peptide; PS, pulmonary stenosis; CPS, critical pulmonary stenosis; IT, intrauterine transport; PT, postnatal transport; ns, no significance.