PO-0491 Managing Neonates With Significant Congenital Heart Disease Outside Specialist Cardiac Centres: A Four-year Retrospective Study

Abstract

Background It has been “standard” for deliveries with antenatal or postnatal diagnoses of significant congenital heart disease (CHD) to be managed at specialist cardiac centres (CC) soon after birth. Capacity constraint in specialist CC has called for change in practice. The appointment of Paediatricians with Expertise in Cardiology (PECs) who work closely with paediatric cardiologists within network, has allowed tertiary neonatal intensive care units (NICU) to manage the appropriately selected deliveries outside CC. Patients were transferred electively to CC when specialist interventions indicated. Aim To review the outcome of neonates with significant CHD initially delivered and managed outside specialist CC. Methodology A four-year retrospective cohort study on a single institution performed. Patients were identified from electronic databases. PDAs, simple ASDs or VSDs, or minor valvular defects were excluded from study. Results A total of 40 neonates identified. Twenty (50%) were antenatal diagnoses and others (50%) postnatal. Antenatal diagnoses include aortic arch anomalies (n = 3, 15%), Fallot’s tetralogy (n = 3, 15%), DORV (n = 4, 20%) and TGA (n = 1, 5%). Seventeen (42.5%) had stable in-patient course and were discharged home for local follow-up. Fourteen (35%) were transferred to CC for specialist interventions within first month of transfer. Total in-patient care duration was 818 days, with average stay of 20.4 days (1–170). Summary We report no adverse events or unexpected outcomes in managing these neonates. Through shared care pathway with nearest specialist cardiac centre and close collaboration with the specialist cardiologists, we have helped to reduce capacity strains on cardiac centres and prevented unnecessary transfers.