Objectives The Tei Index (TI) is a useful, non-invasive

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 ...

Background-Anti-SSA/Ro-associated third-degree congenital heart block is irreversible, prompting a search for early markers and effective therapy. Methods and Results-One hundred twenty-seven pregnant women with anti-SSA/Ro antibodies were enrolled; 95 completed an evaluable course in 98 pregnancies. The protocol included fetal echocardiograms performed weekly from 16 to 26 weeks' gestation and biweekly from 26 to 34 weeks. PR intervals Ͼ150 ms were considered prolonged, consistent with first-degree block. Ninety-two fetuses had normal PR intervals. Neonatal lupus developed in 10 cases; 4 were neonatal lupus rash only. Three fetuses had third-degree block; none had a preceding abnormal PR interval, although in 2 fetuses Ͼ1 week elapsed between echocardiographic evaluations. Tricuspid regurgitation preceded third-degree block in 1 fetus, and an atrial echodensity preceded block in a second. Two fetuses had PR intervals Ͼ150 ms. Both were detected at or before 22 weeks, and each reversed within 1 week with 4 mg dexamethasone. The ECG of 1 additional newborn revealed a prolonged PR interval persistent at 3 years despite normal intervals throughout gestation. No first-degree block developed after a normal ECG at birth. Heart block occurred in 3 of 16 pregnancies (19%) in mothers with a previous child with congenital heart block and in 3 of 74 pregnancies (4%) in mothers without a previous child with congenital heart block or rash (Pϭ0.067). Conclusions-Prolongation of the PR interval was uncommon and did not precede more advanced block. There was a trend toward more congenital heart block in fetuses of women with previously affected offspring than those without previously affected offspring. Advanced block and cardiomyopathy can occur within 1 week of a normal echocardiogram without initial first-degree block. Echodensities and moderate/severe tricuspid regurgitation merit attention as early signs of injury. (Circulation. 2008;117:485-493.)