Abstract
ObjectiveThis study aims to investigate the incidence of postnatal diagnosis of congenital heart disease (CHD) and the predictive factors for hospital mortality.MethodsThis retrospective cohort study was conducted at a Brazilian tertiary center, and data were collected from medical records with inclusion criteria defined as any newborn with CHD diagnosed in the postnatal period delivered between 2015 and 2017. Univariate and multivariate analyses were performed to determine the potential risk factors for mortality.ResultsDuring the 3-year period, 119 (5.3%) children of the 2215 children delivered at our institution were diagnosed with CHD. We considered birth weight (P=0.005), 1st min Apgar score (P=0.001), and CHD complexity (P=0.013) as independent risk factors for in-hospital mortality. The most common CHD was ventricular septal defect. Indeed, 60.5% cases were considered as "complex" or "significant" CHDs. Heart surgeries were performed on 38.9% children, 15 of whom had "complex" or "significant" CHD. A mortality rate of 42% was observed in this cohort, with 28% occurring within the initial 24 h after delivery and 38% occurring in patients admitted for heart surgery.ConclusionThe postnatal incidence of CHD at our service was 5.3%. Low 1st min Apgar score, low birth weight, and CHD complexity were the independent factors that affected the hospital outcome.
Highlights
Congenital heart diseases (CHDs), the leading abnormalities in fetuses, are six times more common than chromosomal abnormalities and four times more common than neural tube defects[1]
Data were collected from the medical records of pregnant women and their newborns diagnosed with CHD
During the 3-year study period, 2215 children were born at our institution, of whom 119 (5.3%) were diagnosed with CHD, and no child was excluded in this study
Summary
Congenital heart diseases (CHDs), the leading abnormalities in fetuses, are six times more common than chromosomal abnormalities and four times more common than neural tube defects[1]. Some countries witness high incidence of CHD possibly due to the implementation of an organized policy to perform ultrasound heart screening[8,9,10]. In Brazil, CHDs are the main cause of death among infants with congenital abnormality, and the implementation of health public policies targeting such population may decrease infant mortality, as occurred in developed countries[11]. A comprehensive assessment of the fetal heart optimizes the diagnosis of CHD, offering appropriate prenatal and postnatal planning and facilitating an improvement in neonatal morbidity and surgical outcome[10,12,13,14,15,16,17]. Newborns with postnatal diagnosis could have unfavorable outcomes because symptoms and cardiovascular impairment may develop at home or in a community hospital, further increasing the morbidity and mortality rates
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