The Impact of Prenatal Diagnosis of Complex Congenital Heart Disease on Neonatal Outcomes

Abstract

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 ...

Diagnosis and Treatment of Fetal Cardiac Disease

“…544,545 Prenatal diagnosis may also predict the need for emergent postnatal intervention such as balloon atrial septostomy for d-TGA, 546,547 atrial septoplasty for HLHS, 176,548,549 or pacing in CHB, 550 thus improving outcome by allowing more rapid stabilization of the postnatal circulation. Finally, although hospital length of stay has been unaffected by prenatal diagnosis in some settings, 544,551 others report earlier time to surgical intervention and reduced length of hospital stay in neonates diagnosed in utero with critical heart disease who undergo biventricular repair. 545 …”

“…564,565 These observations are juxtaposed to concerning data from recent studies that have identified a small but significant negative trend in gestational age at delivery in infants with single-ventricle defects when diagnosed prenatally. 544,551,566 Close communication between obstetric and cardiology services is essential in this setting because elective induction for fetuses with CHD before 39 weeks is not recommended unless there are patient-specific obstetric or logistic issues or fetus-specific concerns about well-being.…”

Risk of critical congenital heart defects by nuchal translucency norms

“…Prenatal detection is therefore particularly important for these newborn infants. [4][5][6][7][8] Over the past decade, first-trimester nuchal translucency (NT) measurement has been used increasingly for prenatal detection of chromosomal abnormalities and has been associated with CCHDs in pregnancies with and without aneuploidy. [9][10][11][12] Although an enlarged NT has been associated with CCHDs (defined by either an NT measurement percentile for crownrump-length [CRL] or by a specific NT measurement in millimeters), [9][10][11]13 having an NT measurement of 3.5 mm is the most commonly applied cutoff at which fetal echocardiography is recommended, based on guidelines of the American College of Obstetricians and Gynecologists.…”

Trends in Mortality in an Australian Tertiary Surgical Neonatal Intensive Care Unit

“…High rates of prenatal diagnoses of congenital heart disease and the state-wide guideline mandating birth of neonates with antenatal diagnosis of heart defects in a co-located perinatal centre could be one of the reasons for this trend [28][29][30]. It has been postulated that efforts to improve prenatal diagnosis and delivery close to a Primary cause of death…”