Risk-Stratified Postnatal Care of Newborns with Congenital Heart Disease Determined by Fetal Echocardiography

Improving maternal–infant bonding after prenatal diagnosis of CHD

“…The natural history of neonatal congenital heart disease is well-established, and has been incorporated into fetal echocardiography standards used to stratify perinatal risk and to direct specialty care 17,18,19,20, 21 . Hypoplastic left heart syndrome with restrictive atrial septal defect, D-transposition of the great arteries with intact ventricular septum, tetralogy of Fallot with absent pulmonary valve, Ebstein’s anomaly of the tricuspid valve, persistent arrhythmias and heart disease causing hydrops fetalis are all high-risk lesions that reliably produce hemodynamic instability; however, most other congenital heart defects do not present immediately at birth.…”

Fetal echocardiography for planning perinatal and delivery room care of neonates with congenital heart disease

“…Recently, the American Heart Association Statement on Fetal Cardiology included a comprehensive protocol, based on evidence from the literature and expert opinion, for perinatal and DR risk stratification of CHD using fetal echocardiographic criteria. While these categories have been named differently (level of care or LOC 1-4 9,13 ; planned CHD to severe-severest CHD 10 ; Care Plan 2-5 11 ; While these various classification systems were designed independently at different centers across the world and reflect the local resources of their specific region, they do share many similarities and common pathways for care (Table 1).…”

“…15 A prenatal diagnosis of such defects now enables institution of PGE1 infusion at delivery, therefore eliminating postnatal compromise. 13 Newborns identified prenatally with ductal-dependent CHD can now be stabilized with a PGE1 infusion through a peripheral or umbilical line and therefore, as long as resources are available, be considered as minimal risk of DR management. 13 Newborns identified prenatally with ductal-dependent CHD can now be stabilized with a PGE1 infusion through a peripheral or umbilical line and therefore, as long as resources are available, be considered as minimal risk of DR management.…”

“…12 In both of these studies, the mortality rate was higher among the group of infants who were diagnosed postnatally, compared to those for which TAPVR was diagnosed after birth. 13 In addition to assessment of the atrial septum and ductus arteriosus, pulmonary vein Doppler may be useful to predict need for BAS. This case resulted in a change to the protocol, with all babies being considered high risk (assigned LOC 3 or 4).…”

“…[6][7][8] For this reason, pregnancy and delivery management of newborns with a prenatal diagnosis of CHD requires a multidisciplinary team, composed of fetal and pediatric cardiologists, obstetricians and maternal-fetal specialists, neonatologists, as well as other pediatric specialists. [9][10][11][12][13] In this article, we aim to review fetal and transitional physiology, the in utero progression of CHD, models of risk stratification and classification of CHD using fetal echocardiography, and strategies for perinatal management of infants with a prenatal diagnosis of CHD. [9][10][11][12][13] In this article, we aim to review fetal and transitional physiology, the in utero progression of CHD, models of risk stratification and classification of CHD using fetal echocardiography, and strategies for perinatal management of infants with a prenatal diagnosis of CHD.…”