Factors associated with the indication of neonatal echocardiography in the investigation of congenital heart diseases

Silva, Mariana Tavares da; Silva, Aline Cerqueira Santos Santana da; Santana, Jhonatan Jhobber; Góes, Fernanda Garcia Bezerra; Assis, Giulia Gazineo Trindade; Matos, Patrícia Salles Damasceno de; Cunha, Adriana Loureiro da

doi:10.1590/1983-1447.2024.20230170.en

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Original Article • Rev. Gaúcha Enferm. 45 • 2024 • https://doi.org/10.1590/1983-1447.2024.20230170.en copy

Factors associated with the indication of neonatal echocardiography in the investigation of congenital heart diseases

Factores asociados a la indicación de la ecocardiografía neonatal en la investigación de cardiopatías congénitas

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the factors associated with the indication of echocardiography for the investigation of congenital heart disease among newborns.

Method:

Retrospective sectional study through the collection of 848 medical records of patients admitted to maternity hospitals in Rio de Janeiro-Brazil, respecting the time frame from September to December 2022.

Results:

The average age of mothers was 26.5±6.3 years; 52.7% were classified as brown. The average age of the newborns was 3.5±5.6 days. Maternal variables: gestational age (OR=6.93, CI:3.76-12.80), number of gestational risk factors (1.90: 1.47-2.45) and number of medications (1. 97: 1.40-2.77); and neonatal variables: age (1.07: 1.03-1.02), prematurity (10.55: 5.29-21.03) and number of risk factors (2.62: 2.03-3 .38) were significantly associated with the indication for echocardiography (p<0.001).

Conclusion:

It is concluded that the different maternal and neonatal variables, gestational age, number of gestational risk factors, number of medications, age, prematurity and number of risk factors, respectively, showed a significant association for the indication of echocardiography. Therefore, the identification of these factors will enable the investigation of congenital heart disease at an opportune time among newborns.

Descriptors:
Heart defects congenital; Echocardiography; Pediatric nursing

Variables	N	%	Mean (±SD)	Min-Max
Age (n=845)			26.5 (±6.2)	14-44
Reported skin color (n=808)
Asian	6	0.8
White	177	21.9
Brown	426	52.7
Black	199	24.6
Education (n=784)
Uneducated	3	0.4
Incomplete primary education	61	7.8
Complete primary education	210	26.8
High school	465	59.3
Number of pregnancies (n=838)			2.3 (±1.6)	1-21
One	298	35.6
Two	255	30.4
Three	158	18.8
Four	72	8.6
Five or more	55	6.6
Number of deliveries (n=676)			1.9 (±1.3)	1-10
One	321	47.5
Two	205	30.3
Three	91	13.5
Four or more	59	8.7
Number of miscarriages (n=844)			0.3 (±0.6)	0-5
None	675	80.1
One	131	15.5
Two or more	37	4.4
Type of delivery (n=846)
Cesarean section	233	27.6
Vaginal birth	613	72.4
Number of prenatal appointments (n=826)			9.0 (±3.1)	0-20
None	9	1.1
1 to 6	141	17.1
7 to 9	315	38.1
10 or more	361	43.7
Gestational age in weeks (n=844)			39.0 (±1.7)	24.4-46.4
Total number of medications taken by the mother			0.5 (±0.7)	0-3
None	506	59.7
One	268	31.6
Two	59	6.9
Three	15	1.8
Total serological reagents			0.8 (±0.9)	0-5
None	619	73.0
One	218	25.7
Two	11	1.3
Gestational risk factors
None	398	47.0
One	287	33.8
Two	119	14.0
Three or more	44	5.2
Gestational risk factors investigated
Diabetes	141	16.6
High blood pressure	136	16.0
Urinary tract infection	70	8.2
Alcoholism	66	7.8
Smoking	57	6.7
Premature labor	38	4.5
Use of illicit drugs	24	2.8
Pre-eclampsia	16	1.9
Hypothyroidism	16	1.9
Syphilis	9	1.1
Anemia	9	1.1
Asthma	6	0.7
Epilepsy	5	0.6
Premature placental displacement	3	0.4
Placenta previa	1	0.1

Variables	N	%	Mean (±SD)	Min-Max
Age in days (n=841)			3.5 (±5.6)	0-37
Birth weight in kilograms (n=847)			3.21 (±0.49)	650.0-4760.0
Premature baby (n=842)
No	785	93.2
Yes	57	6.8
Baby referred to the NICU^*(n=842)
No	805	95.6
Yes	37	4.4
Weight classification (n=835)
Appropriate for gestational age	699	83.7
Small for gestational age	65	7.8
Large for gestational age	71	8.5
SPO2 values - UL^**
Below 95%	1	0.1
96 - 97%	33	3.8
98 - 99%	218	25.7
100%	571	67.3
Not informed	26	3.1
SPO2values- LL^**
Below 95%	0	0
96 - 97%	29	3.4
98 - 99%	186	21.8
100%	605	71.3
Not informed	26	3.1
Total risk factors for the newborn			0.6 (±0.9)	0-6
None	519	61.0
One	239	28.1
Two	61	7.2
Three or more	30	3.7
Risk factors for the newborn
Maternal infection	164	19.3
Prematurity	56	6.6
Malformation	30	3.5
Breathing disorder	22	2.6
Jaundice	19	2.2
PROM^***	17	2.0
Hypoglycemia	16	1.9
Congenital syphilis	15	1.8
Meconium	14	1.6
ABO^*** status	14	1.6
Twinship	8	0.9
Urinary tract infection	6	0.7
Asphyxiation	5	0.6
Indication for echocardiography
Indicated	45	5.3
Not indicated	803	94.7
Congenital heart disease (n=45)
Yes	31	68.9
No	14	31.1

Variables	OR	CI 95%	P value
Maternal Characteristics
Age^*	1.04	0.99-1.08	0.148
Reported skin color^*
White	1.0
Non-white	0.72	0.32-1.67	0.453
Education^*
Complete primary education	0.63	(0.23-1.72)	0.370
Uneducated/incomplete primary education	0.83	(0.19-3.67)	0.810
Gestational age in weeks^*
38-42 weeks	1.0
≤37 or ≥43 weeks	6.93	3.76-12.80	<0.001
Number of pregnancies^*	1.05	0.89-1.23	0.599
Number of deliveries^*	1.06	0.86-1.30	0.603
Number of miscarriages^*	1.35	0.89-2.03	0.156
Number of prenatal appointments^*	1.04	0.94-1.14	0.483
Number of gestational risk factors	1.90	1.47-2.45	<0.001
Total serological reagents	0.72	0.36-1.43	0.343
Number of medications taken by the mother	1.97	1.40-2.77	<0.001
Presence of diabetes
No	1.0
Yes	5.50	2.97-10.18	<0.001
Presence of high blood pressure
No	1.0
Yes	1.78	0.87-3.56	0.237
Characteristics of the newborn
Age in days^*	1.07	1.03-1.02	<0.001
Weight classification^*
Appropriate for gestational age	1.0
Small for gestational age	2.12	0.85-5.28	0.106
Large for gestational age	2.88	0.97-5.37	0.901
Premature baby^*
No	1.0
Yes	10.55	5.29-21.03	<0.001
Number of risk factors for the newborn	2.62	2.03-3.38	<0.001
Birth weight^*	1.00	0.99-1.00	0.163
Saturation in upper limbs^*	0.94	0.63-1.40	0.744
Saturation in lower limbs^*	1.00	0.65-1,55	0.994

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[1] Corresponding author:
Mariana Tavares da Silva E-mail: marianatavaresds@gmail.com