Improvement in Antenatal Diagnosis of Critical Congenital Heart Disease Implications for Postnatal Care and Screening

Israel, Stephanie W.; Roofe, Lindsay R.; Saville, Benjamin R.; Walsh, William F.

doi:10.1159/000327148

Cited by 14 publications

(10 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The “diagnostic gap,” as defined by Riede et al [21], is the percentage of neonates with CCHD who are undiagnosed at the time of hospital discharge. Second, we re-examined the timing of CCHD diagnosis in Middle Tennessee to corroborate our previous research, which concluded that 49–66 % of infants with CCHD are prenatally diagnosed [9, 24]. …”

Section: Methodssupporting

confidence: 67%

“…In the study by Ewer et al [6], both infants with undetected CCHD had CoA (one with associated transposition of the great arteries and ventricular septal defect), and an additional three infants presented with CoA after the age of 28 days. Therefore, despite the institution of CCHD screening using pulse oximetry, up to 40 % of infants with CoA will remain undetected [6, 13, 9]. …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluating the Diagnostic Gap: Statewide Incidence of Undiagnosed Critical Congenital Heart Disease Before Newborn Screening With Pulse Oximetry

Mouledoux

Walsh

2013

Pediatr Cardiol

Self Cite

View full text Add to dashboard Cite

Screening for critical congenital heart disease (CCHD) using pulse oximetry has been endorsed by the American Academy of Pediatrics and the American Heart Association. We sought to determine the incidence of undetected CCHD in Tennessee and the diagnostic gap of CCHD in Middle Tennessee prior to screening implementation. The Tennessee Initiative for Perinatal Quality Care (TIPQC) Undetected CCHD Registry is a quality improvement initiative established to identify neonates discharged from the nursery with undetected CCHD. The TIPQC database was queried and a simultaneous review of all neonates with CCHD in the Middle Tennessee region was performed to define the incidence and identify the pre-screen diagnostic gap of undetected CCHD at the time of hospital discharge. In 2011, of 79,462 live births in Tennessee, 12 newborns had undiagnosed CCHD (incidence 15 per 100,000; 95 % CI 9–26 per 100,000). Nine of 12 (75 %) had coarctation of the aorta (CoA). There were no deaths due to undiagnosed CCHD. In the Middle Tennessee region, 6 of 45 neonates with CCHD were missed, for a diagnostic gap of 13 % (95 % CI 6–26 %). Prior to implementation of CCHD screening using pulse oximetry, 12 Tennessee neonates with CCHD were missed by prenatal ultrasound and newborn examination. CoA was the most common lesion missed and is also the CCHD most likely to be missed despite addition of screening using pulse oximetry. Continued evaluation of the diagnostic gap with particular attention to missed diagnoses of CoA should accompany institution of CCHD screening programs.

show abstract

Section: Methodssupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Evaluating the Diagnostic Gap: Statewide Incidence of Undiagnosed Critical Congenital Heart Disease Before Newborn Screening With Pulse Oximetry

Mouledoux

Walsh

2013

Pediatr Cardiol

Self Cite

View full text Add to dashboard Cite

show abstract

“…This fact, as well as the large number of tertiary care hospitals in Massachusetts, may have contributed to the high rates of prenatal diagnosis we observed, which are higher than those seen in many other states. 21,22 Although rates declined during the 5-year study period, delayed diagnosis continues to occur, with rates highest among isolated cases and those delivered at nontertiary care hospitals. Pulse oximetry screening of asymptomatic newborns was recently mandated in Massachusetts, with the goal of reducing this rate even further.…”

Section: Discussionmentioning

confidence: 99%

Delayed Diagnosis of Critical Congenital Heart Defects: Trends and Associated Factors

et al. 2014

View full text Add to dashboard Cite

OBJECTIVE: We aimed to examine trends in timing of diagnosis of critical congenital heart defects (CCHDs) and factors associated with delayed diagnosis (diagnosis after discharge home following delivery). METHODS: We examined a population-based retrospective cohort of CCHD cases among live births identified through the Massachusetts Birth Defects Monitoring Program. Congenital heart defects were considered critical if the infant received corrective surgery, interventional catheterization, palliative care, or died as a result of the defect within 12 months of birth. Timing of initial diagnosis was classified as prenatal, postnatal before discharge home, or delayed. Demographic, perinatal, and mortality information was obtained from the Registry of Vital Records and Statistics. Prevalence ratios (PRs) were used to examine associations with delayed diagnosis. RESULTS: Among 460 467 live births to Massachusetts residents between 2004 and 2009, we identified 916 CCHD cases, of which 126 (13.8%) had delayed diagnosis. Rates of prenatal CCHD diagnosis increased from 44.9% in 2004 to 63.8% in 2009, whereas rates of delayed diagnosis decreased from 17.1% to 10.6% over the same time period. Among cases with delayed diagnosis, the most common defects were coarctation, pulmonary valve stenosis, and tetralogy of Fallot. Delayed diagnosis was associated with delivery outside a tertiary hospital (adjusted PR: 3.6 [95% confidence interval: 2.5–5.2]) and isolated CCHD (adjusted PR: 1.7 [95% confidence interval: 1.1–2.7]). CONCLUSIONS: Despite increasing prenatal diagnosis of CCHDs, delayed diagnosis still occurs in over 10% of cases. Understanding factors associated with delayed diagnosis could help to improve prenatal and postnatal screening efforts, including pulse oximetry testing.

show abstract

“…Na literatura, estão descritas taxas de DPN de cardiopatias congénitas de 47,3% em França, 49% nos Estados Unidos e 52,8% na Austrália. 7,8,13 Em Portugal, a Direção Geral da Saúde publicou em 2006 um conjunto de indicações para a realização de ecocardiografia fetal, salientando que na generalidade das gravidezes, a realização de uma ecografia do segundo trimestre de qualidade permite identificar a maioria dos fetos que deverão ser submetidos a estudo ecocardiográfico.…”

Section: Discussionunclassified

Cardiopatias Congénitas Complexas: Influência do Diagnóstico Pré-Natal

Correia

Fortunato²,

Martins

et al. 2015

Acta Med Port

View full text Add to dashboard Cite

Introduction:Complex congenital heart disease is a group of severe conditions. Prenatal diagnosis has implications on morbidity and mortality for most severe conditions. The purpose of this work was to evaluate the influence of prenatal diagnosis and distance of residence and birth place to a reference center, on immediate morbidity and early mortality of complex congenital heart disease. Material and Methods:Retrospective study of complex congenital heart disease patients of our Hospital, born between 2007 and 2012. Results: There were 126 patients born with complex congenital heart disease. In 95%, pregnancy was followed since the first trimester, with prenatal diagnosis in 42%. There was a statistically significant relation between birth place and prenatal diagnosis. Transposition of great arteries was the most frequent complex congenital heart disease (45.2%), followed by pulmonary atresia with ventricular septal defect (17.5%) and hypoplastic left ventricle (9.5%). Eighty-two patients (65.1%) had prostaglandin infusion and 38 (30.2%) were ventilated before an intervention. Surgery took place in the neonatal period in 73%. Actuarial survival rate at 30 days, 12 and 24 months was 85%, 80% and 75%, respectively. There was no statistically significant relation between prenatal diagnosis and mortality. Discussion: Most patients with complex congenital heart disease did not have prenatal diagnosis. All cases with prenatal diagnosis were born in a tertiary center. Prenatal diagnosis did not influence significantly neonatal mortality, as already described in other studies with heterogeneous complex heart disease. Conclusion: prenatal diagnosis of complex congenital heart disease allowed an adequate referral. Most patients with complex congenital heart disease weren't diagnosed prenatally. This data should be considered when planning prenatal diagnosis of congenital heart disease. Keywords: Heart Defects, Congenital; Prenatal Diagnosis. INTRODUÇÃOAs cardiopatias congénitas são as malformações congénitas major mais comuns e constituem o grupo com maior relevância clínica, com uma prevalência de 0,5% a 1% no período neonatal.1-3 Cerca de metade destas cardiopatias são graves e necessitam de intervenção no período neonatal ou nos primeiros anos de vida. 2As cardiopatias congénitas complexas (CCC) constituem um grupo de doenças graves e incluem na sua grande maioria uma alteração do arranjo segmentar, sendo exemplos o síndrome de coração esquerdo hipoplásico (SCEH), transposição das grandes artérias (TGA) e o coração univentricular. De entre as cardiopatias congénitas,

show abstract

Improvement in Antenatal Diagnosis of Critical Congenital Heart Disease Implications for Postnatal Care and Screening

Cited by 14 publications

References 27 publications

Evaluating the Diagnostic Gap: Statewide Incidence of Undiagnosed Critical Congenital Heart Disease Before Newborn Screening With Pulse Oximetry

Evaluating the Diagnostic Gap: Statewide Incidence of Undiagnosed Critical Congenital Heart Disease Before Newborn Screening With Pulse Oximetry

Delayed Diagnosis of Critical Congenital Heart Defects: Trends and Associated Factors

Cardiopatias Congénitas Complexas: Influência do Diagnóstico Pré-Natal

Contact Info

Product

Resources

About