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Impact of prenatal diagnosis on the management and early outcome of critical duct-dependent cardiac lesions

Published online by Cambridge University Press:  07 February 2018

Varsha Thakur ,
Nathalie Dutil ,
Steven M. Schwartz  and
Edgar Jaeggi
Varsha Thakur*
Affiliation:
Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada
Nathalie Dutil
Affiliation:
Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada
Steven M. Schwartz
Affiliation:
Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada
Edgar Jaeggi
Affiliation:
Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada
*
Correspondence to: V. Thakur, MD, FRCPC, The Hospital for Sick Children, 555 University Avenue Toronto, Ontario, Canada, M5G 1X8. Tel: +416 813 7466; Fax: +416 813 7547; E-mail: varsha.thakur@sickkids.ca
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Abstract

Objective

The objective of this study was to compare the preoperative management and outcome of neonates with duct-dependent critical CHD with fetal versus postnatal diagnosis.

Methods

Patients referred with CHD to our centre from January 1, 2009 to December 31, 2010 were enrolled prospectively. Live births with a critical form of CHD, a gestational age ⩾36 weeks and a weight ⩾2 kg at birth, and the intention-to-treat were included in this sub-study. Excluded were neonates with lethal non-cardiac and/or genetic anomalies.

Results

In total, 129, 63 fetal and 66 postnatal, cases met the study inclusion criteria. All had received appropriate antenatal care, including a routine fetal anatomy scan. Both cohorts were comparable in weight, gestational age, and APGAR scores at birth. Unlike the postnatal cases, there were no deaths (0/63 versus 5/66; p=0.06) and no cardiac arrests (0/63 versus 9/63; p=0.003) before surgery or catheter intervention in those cases with a prenatal diagnosis of critical CHD. Moreover, newborns with fetal diagnoses were admitted earlier (median 0 (range 0–3) versus 2 (0–25) days; p<0.001) and were less likely to require preoperative ventilation (19/63 versus 31/61, p=0.03) and vasoactive medication (4/63 versus 15/61, p=0.006) than the postnatal cases.

Conclusions

Prenatal diagnosis of critical CHD in this study was associated with significantly shorter time intervals from birth to neonatal admission and the absence of life-threatening or fatal preoperative cardiac events. Increased efforts should be made to improve rates of prenatal diagnosis.

Keywords

FetalcardiacCHDechocardiographyoutcome
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 4 , April 2018 , pp. 548 - 553
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Copyright
© Cambridge University Press 2018 

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