Abstract
BackgroundFor major congenital heart disease, the benefits of antenatal diagnosis on some post-natal measures have been suggested. However, findings have been inconclusive and focus on short term outcome measures alone with little data from a UK population. Our aim is to describe differences in reported outcomes for patients born with isolated Hypoplastic Left Heart Syndrome or Transposition of the Great Arteries in a UK population, following either antenatal or postnatal diagnosis.MethodsRetrospective population-based study with case note review covering a 15 year period (1st January 1998 to 31st December 2012) in the British county of Leicestershire. Cases were identified from two local registers: the East Midlands and South Yorkshire Congenital Anomaly Register and a list of surgical patient held by the East Midlands Congenital Heart Centre.ResultsIn total 52 cases of Hypoplastic Left Heart Syndrome or Transposition of the Great Arteries were identified with 24 (46.2%) diagnosed antenatally. Maximum and minimum follow up was 181 and 16 months respectively. Median follow up was 83 months (IQR: 44–111).The risk of intubation in the postnatal period (OR: 4.64, 95% CI: 1.40 - 15.32) was greater in cases of Hypoplastic Left Heart Syndrome or Transposition of the Great Arteries diagnosed after birth when compared to those diagnosed antenatally. There was a non-significant increase in the risk of metabolic acidosis in the postnatal period (OR: 12.5, 95% CI: 0.64 - 245.46). No differences in mortality or long-term outcomes were demonstrated between antenatally and postnatally diagnosed cohorts.ConclusionsThese results confirm data from American and European populations that, for a British population, an antenatal diagnosis of a major congenital heart disease can have a favourable impact on some postnatal outcome measures. There appears to be no evidence that time of diagnosis impacts on long-term outcome measures.
Highlights
For major congenital heart disease, the benefits of antenatal diagnosis on some post-natal measures have been suggested
Where the child is affected by major congenital heart disease that is essentially unstable, this can lead to haemodynamic compromise and result in emergency admission
Study design This study comprised a retrospective analysis of outcome data in patients diagnosed with Hypoplastic Left Heart Syndrome or Transposition of the Great Arteries whose mothers lived within the British county of Leicestershire, which has an annual birth rate of approximately 11,000 per year
Summary
For major congenital heart disease, the benefits of antenatal diagnosis on some post-natal measures have been suggested. It has been suggested that short term outcomes in congenital heart disease would improve with antenatal diagnosis because birth in an appropriate setting can be planned in terms of the timing of delivery and immediate access to specialist staff and facilities [3]. Those neonates without an antenatal diagnosis are at risk of discharge without their condition being identified, despite routine baby checks. Access to surgical intervention may be delayed, or else undertaken with the patient in a sub-optimal condition [4]
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