失われた機会: 産前心臓緩和ケアに関する単一センターの洞察
Hannah Tredway1, Katie Moynihan1, Hadley Bloomhardt2
1Department of Cardiology, Boston Children's Hospital, Boston, MA,; Department of Pediatrics, Harvard Medical School.
The Journal of pediatrics
|August 23, 2025
まとめ
生前緩和ケア (PC) は,重篤な先天性心疾患 (CCHD) の利用が不十分であり,診察を受ける患者はわずか12%である. 高リスクのCCHD症例に対する定期的なPCは,ケアを改善することができます.
科学分野:
- 小児心臓科
- 緩和ケア
- 新生児医学
背景:
- 深刻な先天性心疾患 (CCHD) は,著しい罹病率と死亡率を示しています.
- サブスペシャリティの緩和ケア (PC) のコンサルティングは,共同意思決定を改善し,家族のストレスを軽減することができます.
- 現在,CCHDの産前PCの使用はよく定義されていません.
研究 の 目的:
- 重篤な先天性心疾患 (CCHD) を診断した患者の産前緩和ケア (PC) の利用率を評価する.
- CCHD患者における早期PC相談に関連する要因を特定する.
- 高リスクのCCHD症例における定期的なPCの診察の必要性を評価する.
主な方法:
- 産前CCHD診断 (2020-2023) の後回顧研究
- 初期入院,PC相談のタイミング,結果に関するデータを収集した.
- 早期 PC は出生前または死亡30日前と定義される.
主要な成果:
- 産前CCHD診断は506件,PC相談は12% (n=61) で,産前は4件でした.
- 初期のPCは遺伝的診断 (61%) または非心臓異常 (61%) の患者でより一般的であった.
- 複雑な新生児手術を受けた患者の18%がPC相談を受け,12%が死亡しました.
結論:
- CCHDに対する妊婦の緩和ケア利用率は低いままです.
- 高リスクのCCHD患者に対する定期的なPCの診察は,ケアを強化するために推奨されます.
- PC統合の改善は,複雑な医療旅行に直面する CCHD 患者や家族を支援することができます.
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