Prenatal echocardiography – the impact on neonatal management

Iwona Jańczewska ,Iwona Domzalska-Popadiuk ,Zbigniew Świątek-Brzeziński

doi:10.22514/sv142.102018.8

Abstract

Congenital heart disease (CHD) results in neonatal morbidity and mortality. Prenatal diagnosis allows preparing an appropriate perinatal and postnatal care. Babies born in low-risk level sites with unexpected CHD may have poorer outcomes. The pur-pose of this study was to compare results of foetal echocardiography to postnatal findings and assess the impact of antenatal suspicions of CHD on postnatal manage-ment. Medical records of mother-infant pairs with CHD admitted to the Neonatal Intensive Care Unit (NICU) of the Medi-cal University of Gdansk from 01.01. to 31.12.2013 were reviewed. We analysed if the defect was detected pre- or postnatally, and if the diagnosis was made by the ob-stetrician from low-risk level sites (level I) or from a tertiary care centre (level II so-nography). The overall incidence of CHD was 68 (3,4%). Critical congenital heart de-fects (CCHD) were found in 24 neonates (1,2%), 21 were diagnosed prenatally, 3 were transferred from 1st level units. Correlation between prenatal diagnosis made at our centre and postnatal findings was achieved in 47,7%. Accuracy in all prenatal and postnatal findings for both I and II sonography levels was 35,2%. There were major differences in the dispropor-tion of the great vessels and postnatal confirmation of coarctation of the aorta (CoAo) (7,1%). We obtained a high ac-curacy of prenatal and postnatal findings in detection of lesions such as Tetralogy of Fallot (ToF), transposition of the great ar-teries (TGA), DORV (double outlet right ventricle) and Critical Pulmonary Steno-sis, which require an outflow tract view (92,9% of cases). Conclusions: We con-firmed increasing diagnostic rates when the diagnostics is performed at a tertiary care centre. These results are in agreement with literature stating that prenatal detec-tion of CoAo is still challenging. Despite the high rates of misdiagnosis, ma-jority of infants benefited from prenatally diagnosed CCHD.&nbsp

Highlights

Congenital heart disease (CHD) results in significant neonatal morbidity and mortality. [1,2] Prenatal diagnosis of CHD is increasingly common; it varies from 16 to 65% depending on the experience of the centre and that of the physician. [3] Previous studies have shown big disparities in detection rate between university centres and peripheral practices
We found low detection rate for septal defects, none of 9 Ventricular Septal Defect (VSD) suspected in level sites (level I) sonography centre and of 1 suspected in level II centre was proved in neonatal echocardiograpy
Many papers showed that prenatal diagnosis of cardiac disease as hypoplastic left heart syndrome (HLHS), coarctation of the aorta (CoAo) or the great arteries (TGA), reduced early neurologic morbidity and improved long-term neurologic outcomes. [13,30,31,32] Of 24 critical CHD (CCHD) detected in our group, 21 were diagnosed on the basis of foetal echocardiography

Summary

Introduction

Congenital heart disease (CHD) results in significant neonatal morbidity and mortality. [1,2] Prenatal diagnosis of CHD is increasingly common; it varies from 16 to 65% depending on the experience of the centre and that of the physician. [3] Previous studies have shown big disparities in detection rate between university centres and peripheral practices. [10] When the defect is detected prenatally and the infant is given PGE as planned, the prognosis for good outcomes of the treatment becomes remarkably better. [11] Berkley et al proposed 5 care plans, depending on the expected severity of CHD, starting from comfort care in case of lethal defects up to a delivery at a tertiary centre with planned delayed surgery at a tertiary cardiac centre or maternal transport with delivery at a tertiary cardiac centre. In case when the prenatally expected severity of a defect and the suggested perinatal care plan are corresponding to the after-birth diagnosis, even if there are some differences in the anatomy of the defect, they can be classified as minor variations in prenatal and postnatal diagnosis. The purpose of this study was to compare results of foetal echocardiography (FECHO) to postnatal findings and to assess the impact of antenatal suspicions of CHD on postnatal management

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Conclusion