Prenatal diagnosis of congenital heart disease (CHD) is increasingly common. However, the current impact of prenatal diagnosis on neonatal outcomes is unclear. Between January 2004 and January 2008, a retrospective chart review of infants who underwent surgical repair of CHD before discharge at our institution was conducted. Obstetric and perioperative variables were recorded. Of 439 neonates, 294 (67%) were diagnosed prenatally (PREdx). Infants with PREdx had a lower mean birth weight (3.0 ± 0.6 vs. 3.1 ± 0.6 kg, p = 0.002) and gestational age (37.9 ± 2.1 vs. 38.6 ± 2.4 wk, p < 0.001) than those with postnatal diagnosis (POSTdx). Severe lesions were more likely to be PREdx:Correspondence to: Allison Levey, ap465@columbia.edu. NIH Public Access Author ManuscriptPediatr Cardiol. Author manuscript; available in PMC 2011 July 1. Many infants with complex CHD require surgical intervention before hospital discharge. Previous studies investigating whether prenatal diagnosis of CHD favorably impacts survival have demonstrated inconsistent findings [9,15]. Likewise, the impact on morbidity has been variably reported [3,4,16]. In light of these mixed reports, and with the knowledge that prenatal diagnosis is now more common than postnatal diagnosis, we sought to reassess the relations between prenatal diagnosis and various neonatal outcomes. First, we evaluated the effect of prenatal diagnosis on birth characteristics, such as gestational age (GA) and birth weight (BW). Second, the differences in anatomic cardiac diagnoses between PREdx and postnatally diagnosed (POSTdx) infants were investigated. Third, we assessed the impact of prenatal diagnosis on neonatal morbidity, including the need for more aggressive preoperative measures, day of life (DOL) of surgery, and hospital length of stay (LOS). Fourth, the effect of prenatal diagnosis on mortality was determined. Finally, we investigated the trends in prenatal diagnosis and the impact of prenatal diagnosis on DOL of surgery and hospital LOS at our institution during the course of the study period. Methods Study Design and ProceduresA retrospective chart review of infants who underwent repair of CHD before hospital discharge between Univariate descriptive statistics are summarized as means and SDs for normal distributions and as medians and interquartile ranges (IQR) for nonparametric distributions. Differences in proportions between groups were analyzed using 2 × 2 tables and Pearson's χ 2 test statistic. Univariate relations were explored using Kaplan-Meier, and differences in medians were assessed using the log-rank test. In an effort to evaluate more fully the associations between prenatal diagnosis and DOL of surgery, hospital LOS, and neonatal mortality, multivariate models were constructed using both binary logistic regression and the Cox Proportional Hazards technique. Subject characteristics that showed a univariable association with DOL of surgery, hospital LOS, and mortality at the 0.1 level were eligible for inclusion in the multivariable models. All ...

This study was undertaken to examine the impact that prenatal diagnosis of congenital heart disease (CHD) has on birth and early neonatal outcomes. The prevalence of prenatally diagnosed CHD has risen over the past decade, but the effect that prenatal diagnosis of CHD has on peripartum decisions remains unclear. No consensus exists on the effect of prenatal diagnosis on neonatal outcomes. Between January 2004 and July 2009, a retrospective chart review of all neonates with CHD admitted to our institution’s neonatal intensive care unit was conducted. Obstetric and postnatal variables were collected. Among the 993 subjects, 678 (68.3 %) had a prenatal diagnosis. A prenatal diagnosis increased the odds of a scheduled delivery [odds ratio (OR) 4.1, 95 % confidence interval (CI) 3.0–5.6] and induction of labor (OR 11.5, 95 % CI 6.6–20.1). Prenatal diagnosis was not significantly associated with cesarean delivery when control was used for maternal age, multiple gestation, and presence of extracardiac anomaly. Mean gestational age had no impact on prenatal diagnosis, but prenatal diagnosis was associated with increased odds of delivery before a gestational age of 39 weeks (OR 1.5, 95 % CI 1.1–1.9) and decreased odds of preoperative intubation (OR 0.5, 95 % CI 0.3–0.6). Prenatal diagnosis did not have an impact on preoperative or predischarge mortality. Prenatal diagnosis was associated with increased odds of a scheduled delivery, birth before a gestational age of 39 weeks, and a decreased need for invasive respiratory support. Prenatal diagnosis of CHD was not associated with preoperative or predischarge mortality.

Congenital coronary artery anomalies are extremely rare causes of early cardiac failure. Several cardiac lesions are associated with coronary anomalies such as pulmonary atresia with intact ventricular septum. Isolated coronary ostial atresia is extremely rare and described in only a few published case reports. To our knowledge, there were two reports of bilateral coronary ostial atresia in which the entire coronary arterial system originated from the right ventricle without other intracardiac defects. We present a case of a full-term infant who presented with severely depressed biventricular function secondary to bilateral coronary ostial atresia.

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