Association of Prenatal Diagnosis of Critical Congenital Heart Disease With Postnatal Brain Development and the Risk of Brain Injury

Peyvandi, Shabnam; Santiago, Veronica De; Chakkarapani, Ela; Chau, Vann; Campbell, Andrew; Poskitt, Kenneth J.; Xu, Duan; Barkovich, A. James; Miller, Steven P.; McQuillen, Patrick S.

doi:10.1001/jamapediatrics.2015.4450

Cited by 127 publications

(111 citation statements)

References 47 publications

(58 reference statements)

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“…55 Similarly, Bonnet and colleagues observed a significant decrease in the neonatal mortality and morbidity when TGA was prenatally detected and appropriately managed. 59 Morris and colleagues investigated the effect of proximity of the birth location to a cardiac surgical facility on the survival of neonates with hypoplastic left heart syndrome. In a retrospective analysis of 596 fetuses with CHD, Donofrio and colleagues demonstrated the value of fetal echocardiography in risk stratification and the consequent optimization of perinatal management.…”

Section: Impact Of Fetal Echocardiographymentioning

confidence: 99%

A brief history of fetal echocardiography and its impact on the management of congenital heart disease

et al. 2017

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Congenital heart disease (CHD), the most common congenital malformation, is associated with adverse outcome. Development of fetal echocardiography has made prenatal diagnosis of CHD a reality, and in the process revolutionized its management. This historical review briefly narrates this development over the decades focusing on the emergence of the primary modalities of fetal echocardiography comprised of the time-motion mode, two-dimensional B-mode, spectral Doppler, color Doppler, and three- and four-dimensional cardiac imaging. Collaboration between clinicians and engineers has been central to these advances. Also discussed are the accuracy and impact of fetal echocardiography on the management of CHD, and especially its role in the prenatal diagnosis of critical CHD in individualizing the management and improving the outcome. Despite these advances, most cases of CHD are not identified prenatally, emphasizing the continuing need for further technological and educational innovation and improvement.

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Section: Impact Of Fetal Echocardiographymentioning

confidence: 99%

A brief history of fetal echocardiography and its impact on the management of congenital heart disease

et al. 2017

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“…Despite not leading to a survival advantage [12, 13], the healthier pre-operative state probably leads to better long-term outcomes overall for those who survive. Specifically, studies have demonstrated improved neurodevelopmental outcomes and better brain health in subjects with TGA and HLHS that are diagnosed prenatally [14, 15]. Conversely, prenatal diagnosis has also been associated with disadvantages in the form of earlier gestational age at delivery and lower birth weights [8].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, prenatal detection of critical CHD has been shown to improve the perioperative condition of these neonates [7, 8, 9, 10, 11]; however, multiple studies have failed to show a survival advantage to prenatal diagnosis [12 13]. Despite not leading to a survival advantage, prenatal diagnosis has been associated with better neurodevelopmental outcome in transposition of the great arteries (TGA) [14] as well as reduced risk of pre-operative brain injury and improved trajectory of postnatal brain development in those with complex CHD [15]. …”

Section: Introductionmentioning

confidence: 99%

Timing and Mode of Delivery in Prenatally Diagnosed Congenital Heart Disease- an Analysis of Practices within the University of California Fetal Consortium (UCfC)

et al. 2017

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Prenatal diagnosis of critical congenital heart disease (CHD) is associated with decreased morbidity. It is also associated with lower birth weights and earlier gestational age at delivery. The University of California Fetal Consortium (UCfC) comprises five tertiary medical centers, and was created to define treatment practices. We utilized this consortium to assess delivery patterns and outcomes in subjects with prenatal and postnatal diagnosis of CHD. A retrospective cohort study was conducted on maternal–neonatal pairs diagnosed with complex CHD prenatally (n = 186) and postnatally (n = 110) from 2011 to 2013. Outcomes were assessed between groups after adjusting for disease severity. Prenatally diagnosed subjects were born earlier (38.1 ± 0.11 vs. 39 ± 0.14 weeks, p = < 0.001), and had lower birth weights (2853 ± 49 vs. 3074 ± 58 g, p = 0.005) as compared to postnatal diagnosis. For every week increase in gestational age and 100 g increase in birth weight, length of stay decreased by 12.3 ± 2.7% (p < 0.001) and 3.9 ± 0.9% (p < 0.001). Subjects with prenatal diagnosis were more often born via cesarean both planned (35.6 vs. 26.2%, p = 0.004) and after a trial of labor (13 vs. 7.8%, p = 0.017). Neonates with cesarean delivery trended toward a longer length of stay (2.6 days longer), and were born earlier as compared to other modalities (37.7 ± 0.22 weeks, p = 0.001). Management after prenatal diagnosis of CHD appears to have modifiable disadvantages for maternal and neonatal outcomes. The UCfC provides a platform to study best practices and standardization of care for future studies.

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“…Patients with critical congenital heart lesions diagnosed antenatally have a better prognosis than those diagnosed postnatally, including a reduced risk of brain injury, as they can be rapidly transferred to a tertiary surgical centre and receive early intervention. 4,7,8 Various international guidelines recommend antenatal anomaly screening, including the need for certain imaging views such as four chamber and ventricular outflow tract assessments. 9 Staff training in obstetric ultrasonography techniques is therefore crucial to improve the antenatal detection of congenital heart diseases.…”

Section: Resultsmentioning

confidence: 99%

Transposition of the Great Arteries and Coarctation of the Aorta in an Infant Presenting with Bronchiolitis: An incidental finding

Al-Mukhaini

Mohamed

2017

SQUMJ

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abstract:The transposition of the great arteries (TGA) is a complex congenital heart disease which usually presents as cyanosis in neonates with limited mixing between the systemic and pulmonary circulatory systems. A delayed diagnosis of TGA can lead to ventricular failure. We report a six-week-old infant who was admitted to the paediatric Intensive Care Unit of the Royal Hospital, Muscat, Oman, in 2016 for bronchiolitis. During admission, she was incidentally diagnosed with TGA and coarctation of the aorta. Postnatal screening, including the use of pulse oximetry, plays a significant role in avoiding a late diagnosis of TGA; however, this screening tool is not widely used in Oman. Moreover, the common practice of applying a pulse oximetry probe only to the foot may have been limited in the current case due to the reverse differential saturation between the upper and lower limbs caused by this particular combination of lesions.

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Association of Prenatal Diagnosis of Critical Congenital Heart Disease With Postnatal Brain Development and the Risk of Brain Injury

Cited by 127 publications

References 47 publications

A brief history of fetal echocardiography and its impact on the management of congenital heart disease

A brief history of fetal echocardiography and its impact on the management of congenital heart disease

Timing and Mode of Delivery in Prenatally Diagnosed Congenital Heart Disease- an Analysis of Practices within the University of California Fetal Consortium (UCfC)

Transposition of the Great Arteries and Coarctation of the Aorta in an Infant Presenting with Bronchiolitis: An incidental finding

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