Rate Of Congenital Heart Disease Research Articles

The Prevalence of Congenital Heart Disease in Nonsyndromic Cleft Lip and/or Palate: A Systematic Review of the Literature.

Life-threatening anomalies, such as congenital heart disease (CHD) must be identified in patients with cleft lip and/or palate (CL/P) to minimize perioperative risk. Nevertheless, screening practices vary highly among cleft teams and programs, and little is known about the prevalence and clinical significance of CHD in nonsyndromic CL/P patients. Through a systematic literature review, this study examines the demographics and severity of CHD in the nonsyndromic CL/P population. The implications of concomitant CHD in providing safe and comprehensive cleft care both in the United States and abroad are discussed. A systematic review of PubMed literature from 1980 to September 2015 was performed following PRISMA guidelines. Studies describing rates of CHD and severity of lesions specifically in nonsyndromic and all CL/P patients were included. Analysis of cumulative data was performed according to nonsyndromic status and cleft type. Twelve studies were found to meet inclusion criteria. Of the 4055 nonsyndromic CL/P patients who met inclusion criteria, 7.42% (n=301) had CHD, which was significantly greater than the general population (~1%; odds ratio [OR], 7.94; P<0.0001). Congenital heart disease was significantly more common in cleft palate (CP) (OR, 15.1), combined CL and palate (CL+P) (OR, 13.5), and CL (OR, 4.23) compared with the general population. Palatal clefts (CP and CL+P) had significantly increased odds of CHD compared with CL (OR, 3.58 and 3.19, respectively, both P<0.0001). The most common forms of CHD were atrial or ventricular septal defects (n=210, 74.2%), which typically do not require surgical intervention in the general population. Clinical significance of these CHD lesions in CL/P patients is not fully known. Cleft management programs aim to maximize the number of patients receiving care while maintaining patient safety. Appropriate evaluation of perioperative risk necessitates understanding the prevalence of CHD in CL/P patients and the severity of those lesions. Patients with CL/P, particularly patients with palatal clefts, have significantly higher odds of having CHD than the general population. Congenital heart disease is most likely to present as atrial or ventricular septal defects, which are lesions that are unlikely to impact safety during cleft repair surgery.

Chromosome microarray analysis in the investigation of children with congenital heart disease

BackgroundOur study was aimed to explore the clinical implication of chromosome microarray analysis (CMA) in genetically etiological diagnosis of children with congenital heart disease (CHD).MethodsA total of 104 children with CHD with or without multiple congenital anomalies (MCA) or intellectual disabilities/developmental delay (ID/DD) but normal karyotype were investigated using Affymetrix CytoScan HD array.ResultPathogenic copy number variations (PCNVs) were identified in 29 children (27.9%). The detection rates in children with simple CHD and complex CHD were 31.1% (19/61) and 23.2% (10/43), respectively. The detection rates of PCNVs were 17.9% (7/39), 20% (5/25), 63.2% (12/19) and 23.8% (5/21) in isolated CHD, CHD plus MCA, CHD plus ID/DD, CHD plus MCA and ID/DD, respectively. The PCNVs rate of CHD plus ID/DD was significantly higher than that of isolated CHD. Two genomic loci including 15q11.2 deletion and 1q43-q44 deletion were considered as CHD locus. The DVL1, SKI, STIM1, CTNNA3 and PLN were identified as candidate genes associated with CHD phenotypes.ConclusionCMA can increase the diagnostic rate and improve the etiological diagnosis in children with CHD. We suggest CMA as a first-tier test in children with CHD, especially in children with CHD plus ID/DD.

Ultrasound Examination of the Fetal Heart.

Congenital heart disease (CHD) occurs in 4-13 per 1000 births in the United States. While many risk factors for CHD have been identified, more than 90% of cases occur in low-risk patients. Guidelines for fetal cardiac screening during the second trimester anatomy ultrasound have been developed by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) in order to improve antenatal detection rates and to standardize the fetal cardiac screening examination. Patients found to be at increased risk of CHD because of risk factors or an abnormal screening examination should be referred for second trimester fetal echocardiography. Recently, 3D and 4D ultrasound techniques are being utilized to enhance detection rates and to better characterize cardiac lesions, and several first trimester ultrasound screening markers have been proposed to identify patients at increased risk of CHD. However, detection rates have not improved significantly due to limitations such as cost, access, and training that are associated with new technologies and screening methods. The most cost effective way to improve detection rates of CHD may be to standardize screening protocols across practices according to established guidelines and to have a low threshold for referral for fetal echocardiography.

The influence of maternal exposure history to virus and medicine during pregnancy on congenital heart defects of fetus.

Congenital heart disease (CHD) is the most common birth defect. It is due to dysfunction of the heart and great vessels during embryo development stage, or the channel was not closed after birth. This study focuses on investigating the influence of virus infection and medicine history during pregnancy on the incidence rate of CHD of fetus. We conducted a retrospective birth cohort study of infant born in the maternal and child health hospital of Fanyu district in Guangzhou. Five thousand three hundred eighty one cases with complete medical records, including mothers, fathers, and infants, were enrolled. The exposure history of mothers to virus and medicine from 6months before pregnancy to prenatal examination was investigated, including mflu, mumps, measles, rubella, chickenpox, and hepatitis and antibiotics, tocolytic agent, anticonvulsants, antipyretic and analgesic, antitumor drug, folic acid supplement, and contraceptive. The relationship between virus infection and medicine history during pregnancy and CHD was analyzed. There was statistical difference between a normal group and a defected group in influenza infection and tocolytic agent and contraceptive pill. The exposure history to influenza and medicines, such as tocolytic agent and contraceptive pill, during pregnancy influenced the incidence rate of CHD of fetus.

Incidence of Congenital Heart Diseases Anomalies in Newborns with Oral Clefts, Zahedan, Iran

Background Oral cleft is the most common orofacial congenital anomaly among live births. This anomaly at birth is one of the main causes of children disability and mortality. Congenital heart disease (CHD) is one of the most common anomalies in oral clefts. This study aimed to assess the incidence of congenital heart diseases anomalies in newborns with oral clefts. Materials and Methods This study performed on 48,692 live born to estimate incidence of oral clefts from 1 st December 2013 to 31 th November 2015 from three general hospitals in Zahedan, The capital city of the Sistan & Baluchestan province, Iran. All oral cleft patients were under echocardiography to diagnosis the incidence of CHD as associated anomaly. The collected data were processed using SPSS-16. Results The results of the analysis showed that the incidence of cleft lip was higher in boys than girls, while the cleft palate was higher in girls. Lip/palate cleft was higher for boys. Oral clefts patients accounted of 102 (0.2%) with incidence rate of 2.095 per 1000 lives. Of 102 patients 19 (18.62%), 39(35.24%) and 44(43.14%) were oral lip, oral palate and both respectively. The incidence of CHD in patients with oral clefts was 26.5%, while the incidences for cleft lip, cleft palate and both were 15.79%, 20.51%, and 36.36% respectively. Conclusion From the study concluded that the rate of CHD among children with oral clefts was high compared with the healthy children. Strongly is suggested the echocardiography for these patients to have early diagnostic of CHD to manage any life-threatening.

Mortality from Congenital Heart Disease in Mexico: A Problem on the Rise.

Background and ObjectivesTemporal trends in mortality from congenital heart disease (CHD) vary among regions. It is therefore necessary to study this problem in each country. In Mexico, congenital anomalies were responsible for 24% of infant mortality in 2013 and CHD represented 55% of total deaths from congenital anomalies among children under 1 year of age. The objectives of this study were to analyze the trends in infant mortality from CHD in Mexico (1998 to 2013), its specific causes, age at death and associated socio-demographic factors.MethodsPopulation-based study which calculated the compounded annual growth rate of death rom CHD between 1998 and 2013. Specific causes, age at which death from CHD occurred and risk factors associated with mortality were analyzed for the year 2013.ResultsInfant mortality from CHD increased 24.8% from 1998 to 2013 (114.4 to 146.4/ 100,000 live births). A total of 3,593 CHD deaths occurred in 2013; the main causes were CHD with left-to-right shunt (n = 487; 19.8/100,000 live births) and cyanotic heart disease (n = 410; 16.7/100,000). A total of 1,049 (29.2%) deaths from CHD occurred during the first week of life. Risk factors associated with mortality from CHD were, in order of magnitude: non-institutional birth, rural area, birth in a public hospital and male sex.ConclusionsMortality from CHD has increased in Mexico. The main causes were CHD with left-to-right shunt, which are not necessarily fatal if treated promptly. Populations vulnerable to death from CHD were identified. Approximately one-third of the CHD occurred during the first week of life. It is important to promote early diagnosis, especially for non-institutional births.

Echocardiographic screening in children and teenagers to be admitted to sports activities

Children and teenagers are a group in which congenital heart disease (CHD) is most commonly considered as a contraindication to sports activities. In this connection, 440 athletes aged 15.6±1.8 years, who had been going for sports for 6.4±2.5 years and who had undergone echocardiography, were examined. The rate of congenital heart disease according to the preliminary diagnoses was 77 (17.5%), that after echocardiographic verification was 238 (54.1%) (p<0.0000). Training volume and intensity limitations were recommended in 114 (47.9%) athletes because of cardiac morphological and functional changes. These changes contradicting sports activities were not found in 124 (52.1%) athletes. Conclusions. 1. EchoCG screening for congenital heart disease is required to define contraindications to sports activities, for it is impossible to establish its diagnosis only on the basis of clinical examination and ECG. 2. The mere fact of CHD is not a contraindication to athletic activities; is necessary to evaluate hemodynamic disorders associated with this pathology. 3. Abnormally located chordae and trabeculae are neither followed by any complications and nor a contradiction to sports activities.

Evaluation of Neurodevelopment and Factors Affecting it in Children With Acyanotic Congenital Cardiac Disease.

Background:The rate of congenital heart disease is 0.8% in all live births. The majority of this, however, is acyanotic congenital heart disease. The survival rate of children with cardiac disease has increased with the developments provided in recent years and their lifetime is extended.Objectives:This study aims to evaluate neurodevelopment of children with uncomplicated acyanotic congenital heart disease in preschool period and determine the factors affecting their neurodevelopmental process.Patients and Methods:132 children with acyanotic congenital heart disease aged 6 - 72 months were involved in the study. Mental development and intelligence levels of patients under 2 years old were assessed by using Bayley Development Scale-III, and Stanford Binet Intelligence test was employed for patients over 2 years old. Denver Developmental Screening Test II was applied to all patients for their personal-social, fine motor, gross motor and language development.Results:The average age of patients (67 girls, 65 boys) included in the study was 35.2 ± 19.6 months. It was determined that there were subnormal mental level in 13 (10%) patients and at least one specific developmental disorder in 33 (25%) patients. Bayley Mental Development Scale score of patients who had received incubator care in perinatal period was found significantly low (88 ± 4.2) compared to those with no incubator care (93.17 ± 8.5) (P = 0.028). Low educational level of father was established to be linked with low mental development scores at the age of 2 and following that age (P < 0.05). Iron deficiency anemia was discovered to be related to low psychometric test scores at every age (P < 0.05).Conclusions:Neurodevelopmental problems in children with acyanotic congenital heart disease were found higher compared to those in society. Mental development and intelligence levels of patients were determined to be closely associated with receiving incubator care, father’s educational level and iron deficiency anemia.

Congenital Heart Disease in Local and Migrant Elementary Schoolchildren in Dongguan, China

The aim of this study was to determine the prevalence and treated status of congenital heart disease (CHD) in elementary schoolchildren and facilitate the long-term planning of health care, resource allocation, and development of targeted primary prevention strategies. From November 2011 to November 2012, 540,574 schoolchildren from 449 elementary schools were screened for CHD by trained doctors in Dongguan City. The schoolchildren who were suspected to have CHD were referred to a pediatric cardiologist and/or an echocardiographist for complete evaluation. Of them, 214,634 (39.7%) were local children and 325,940 (60.3%) were migrant children. The total prevalence of CHD was 2.14‰, and there was a significant difference (p <0.05) of the CHD prevalence between local (1.97‰) and migrant children (2.26‰). The treatment rates of CHD in local children and in migrant children were 63.51% and 47.21%, respectively (p <0.01). The commonest CHD was ventricular septal defect (43.13%), followed by atrial septal defect (25.84%) and patent ductus arteriosus (12.79%). With respect to gender, CHD was equally distributed between men and women. In conclusion, social, economic, and environmental risk factors that affect health of migrant children with CHD call for more attention from health policy makers and researchers in contemporary China. Efforts should be made to increase public health investment, establish health care manage system for children from migrant families, and increase the parents' awareness of preventing the CHD.

Abstract 14197: Industrial Developmental Toxicant Emissions and Congenital Heart Disease in Urban and Rural Alberta, Canada

Background: We have previously demonstrated a downward temporal association between mixtures of organic solvents released into air from industrial sources and congenital heart disease (CHD) in Alberta. Hypothesis: In the current study we hypothesized that the downward temporal associations between developmental toxicants (DTs) and CHD would have a different industrial sector participation in the urban and rural areas of Alberta. Methods: We extracted yearly emissions of DTs (tonnes) from Canada’s National Pollutant Release Inventory as released to air between 2003-2010. We identified at the postal code level, all CHD cases born between 2004-2011 through our provincial-wide echocardiography database. We calculated yearly urban and rural CHD crude rates. Urban and rural were defined according to Forward Sortation Areas. Principal Component Analysis was undertaken to reduce the dimensionality of the number of DTs and the yearly solution was applied to rural and urban areas to test correlations with corresponding yearly CHD rates. Results: Three principal components (PCs) were identified: PC1 consisted of a mixture of organics and gases, PC2 consisted of a mixture of organics only and PC3 consisted of metals. There were strong positive correlations between CHD rates and urban PC1 emissions from mining and manufacturing, (r=0.76, p=0.03; 0.74, p=0.04); whereas in rural areas, PC1 emissions from mining and utilities and PC2 emissions from mining and manufacturing were associated with rates of CHD, (r=0.71, p=0.05; r=0.74, p=0.04 and r=0.86, p=0.01; r=0.74, p=0.04, respectively). PC3 showed no positive correlations (Table 1). Conclusions: CHD rates are consistently strongly correlated with mixtures of organic compounds and gases, with different patterns of chemicals and sectors involved in the urban and rural settings. This provides an opportunity to further investigate spatial correlations between DTs and CHD rates at a higher resolution scale.

The Application of an Anatomical Database for Fetal Congenital Heart Disease.

Background:Fetal congenital heart anomalies are the most common congenital anomalies in live births. Fetal echocardiography (FECG) is the only prenatal diagnostic approach used to detect fetal congenital heart disease (CHD). FECG is not widely used, and the antenatal diagnosis rate of CHD varies considerably. Thus, mastering the anatomical characteristics of different kinds of CHD is critical for ultrasound physicians to improve FECG technology. The aim of this study is to investigate the applications of a fetal CHD anatomic database in FECG teaching and training program.Methods:We evaluated 60 transverse section databases including 27 types of fetal CHD built in the Prenatal Diagnosis Center in Peking University People's Hospital. Each original database contained 400–700 cross-sectional digital images with a resolution of 3744 pixels × 5616 pixels. We imported the database into Amira 5.3.1 (Australia Visage Imaging Company, Australia) three-dimensional (3D) software. The database functions use a series of 3D software visual operations. The features of the fetal CHD anatomical database were analyzed to determine its applications in FECG continuing education and training.Results:The database was rebuilt using the 3D software. The original and rebuilt databases can be displayed dynamically, continuously, and synchronically and can be rotated at arbitrary angles. The sections from the dynamic displays and rotating angles are consistent with the sections in FECG. The database successfully reproduced the anatomic structures and spatial relationship features of different fetal CHDs. We established a fetal CHD anatomy training database and a standardized training database for FECG. Ultrasound physicians and students can learn the anatomical features of fetal CHD and FECG through either centralized training or distance education.Conclusions:The database of fetal CHD successfully reproduced the anatomic structures and spatial relationship of different kinds of fetal CHD. This database can be widely used in anatomy and FECG teaching and training.

Neighbourhood Deprivation, Individual-Level and Familial-Level Socio-demographic Factors and Risk of Congenital Heart Disease: A Nationwide Study from Sweden.

The purpose of the study is to examine whether there is an association between neighbourhood deprivation and incidence of congenital heart disease (CHD), after accounting for family- and individual-level potential confounders. All children aged 0 to 11 years and living in Sweden (n = 748,951) were followed between January 1, 2000 and December 31, 2010. Data were analysed by multilevel logistic regression, with family- and individual-level characteristics at the first level and level of neighbourhood deprivation at the second level. During the study period, among a total of 748,951 children, 1499 (0.2%) were hospitalised with CHD. Age-adjusted cumulative hospitalisation rates for CHD increased with increasing level of neighbourhood deprivation. In the study population, 1.8 per 1000 and 2.2 per 1000 children in the least and most deprived neighbourhoods, respectively, were hospitalised with CHD. The incidence of hospitalisation for CHD increased with increasing neighbourhood-level deprivation across all family and individual-level socio-demographic categories. The odds ratio (OR) for hospitalisation for CHD for those living in high-deprivation neighbourhoods versus those living in low-deprivation neighbourhoods was 1.23 (95% confidence interval (CI) = 1.04-1.46). In the full model, which took account for age, paternal and maternal individual-level socio-economic characteristics, comorbidities (e.g. maternal type 2 diabetes, OR = 3.03; maternal hypertension, OR = 2.01), and family history of CHD (OR = 3.27), the odds of CHD were slightly attenuated but did not remain significant in the most deprived neighbourhoods (OR = 1.20, 95% CI = 0.99-1.45, p = 0.057). This study is the largest so far on neighbourhood influences on CHD, and the results suggest that deprived neighbourhoods have higher rates of CHD, which represents important clinical knowledge. However, the association does not seem to be independent of individual- and family-level characteristics.

G170(P) Improving antenatal detection rates of significant congenital cardiac lesions in a district general hospital

Introduction Congenital heart disease (CHD) affects around 1% of pregnancies in the UK each year. Around half of these are major cardiac lesions requiring surgery or intervention within the 1 st year of life. Studies show that if CHD is detected before birth, there are significant benefits for babies, their families and for medical services around the time of birth and in the first year of life. Prenatal diagnosis and appropriate treatment may prevent the devastating consequences of early circulatory collapse, such as death and ischaemic brain damage. Background An audit previously conducted in our district general hospital found that the antenatal detection rate of significant cardiac lesions in Jan 1998–Dec 1999 was 17.6%. Following this, new ultrasound machines were purchased and ultrasonographers received training to perform outlet views of the fetal heart as well as 4 chamber views. Aims The aims of this audit were 1) to establish whether this intervention has led to improved antenatal detection of significant CHD and 2) to compare these detection rates with national figures. Methods Antenatal detection rates of CHD were again audited for all babies who received an anomaly scan in Jan 2009–Dec 2010. Children with significant CHD were identified through their attendance at cardiac clinic. We then looked retrospectively at each child’s anomaly scan (18+0 – 20+6 weeks gestation) and recorded whether or not a cardiac lesion had been detected antenatally. We also reviewed data from the South West Congenital Anomoly Register (SWCAR) and local electronic and paper records by which method we were able to include antenatally detected significant CHD in foetuses who did not survive. Results Following the intervention antenatal detection of significant CHD rose to 72%. This compares with national detection rates of around 30% over the same period. Conclusion Our findings confirm the necessity of cardiac outlet views along side 4-chamber views as part of antenatal anomaly scanning with good supervision and support from local and regional Fetal Medicine Specialists.

Prenatal detection of congenital heart disease in a low risk population undergoing first and second trimester screening.

The prenatal detection rate of congenital heart disease (CHD) is low compared with other fetal malformations. Our aim was to evaluate the prenatal detection of CHD in Eastern Denmark. Fetuses and infants diagnosed with CHD in the period 01.01.2008-31.12.2010 were assessed regarding prenatal detection rate and accuracy, as well as correlation with nuchal translucency (NT) thickness. Out of 86 121 infants, 831 were born with CHD (0.96%). The prenatal detection rate of 'all CHD' was 21.3%, of 'Major CHD' 47.4%. Full agreement between prenatal and postnatal/autopsy findings was found in 96% of prenatally detected diagnoses. An NT thickness >95(th) percentile was found in 15.0% fetuses with 'Major CHD'. Of 'Major CHDs' detected prenatally, 77% were picked up at the time of the malformation scan at weeks 18-21. Nearly half of 'Major CHDs' were detected prenatally. The prenatal cardiac diagnoses showed a high degree of accuracy. Increased NT thickness as a screening tool for CHD performed moderately but is an important high risk group for specialist examination. A minority of the prenatally detected CHDs was identified because of extra scans performed in high risk pregnancies. © 2014 John Wiley & Sons, Ltd.

Prenatal detection of congenital heart disease--results of a national screening programme.

Congenital heart disease (CHD) is the most common congenital malformation and causes major morbidity and mortality. Prenatal detection improves the neonatal condition before surgery, resulting in less morbidity and mortality. In the Netherlands a national prenatal screening programme was introduced in 2007. This study evaluates the effects of this screening programme. Geographical cohort study. Large referral region of three tertiary care centres. Fetuses and infants diagnosed with severe CHD born between 1 January 2002 and 1 January 2012. Cases were divided into two groups: before and after the introduction of screening. Detection rates were calculated. The prenatal detection rate (n = 1912) increased with 23.9% (95% confidence interval [95% CI] 19.5-28.3) from 35.8 to 59.7% after the introduction of screening and of isolated CHD with 21.4% (95% CI 16.0-26.8) from 22.8 to 44.2%. The highest detection rates were found in the hypoplastic left heart syndrome, other univentricular defects and complex defects with atrial isomerism (>93%). Since the introduction of screening, the 'late' referrals (after 24 weeks of gestation) decreased by 24.3% (95% CI 19.3-29.3). This is the largest cohort study to investigate the prenatal detection rate of severe CHD in an unselected population. A nationally organised screening has resulted in a remarkably high detection rate of CHD (59.7%) compared with earlier literature.

The survey of birth defects rate based on birth registration system.

Background:To investigate the surveillance trend of birth defects, incidence, distribution, occurrence regularity, and their relevant factors in Xi’an City in the last 10 years for proposing control measures.Methods:The birth defects monitoring data of infants during perinatal period (28 weeks of gestation to 7 days after birth) were collected from obstetrics departments of all hospitals during 2003–2012. Microsoft Excel 2003 was used for data input, and Statistical Package for the Social Sciences version 16.0 (International Business Machines Corporation, New York, NY, USA) was used for descriptive analysis. χ2 test, Spearman correlation and linear-by-linear association trend test were used for statistical analyses.Results:The birth defect rate declined from 9.18% in 2003 to 7.00% in 2012 (χ2 = 45.001, P < 0.01) with a mean value of 7.85%, which is below the Chinese national average level (χ2 = 20.451, P < 0.01). The order of five most common birth defects has changed. The incidence of congenital heart disease (CHD) increased with time, particularly after 2012, it became the most frequent type (rs = 0.808, P < 0.001). Till then, the number of neural tube defects (NTDs) declined significantly (χ2 = 76.254, P < 0.01). The average birth defects rate of 8.11% in rural areas was higher than that in urban areas (7.56%, χ2 = 7.919, P < 0.01) and much higher in males (8.28%) than that in females (7.18%, χ2 = 32.397, P < 0.01). Maternal age older than 35 years (χ2 = 35.298, P < 0.01) is the most dangerous age bracket of birth defects than maternal age younger than 20 years (χ2 = 7.128, P < 0.01).Conclusions:A downward trend of birth defects was observed in Xi’an City from 2003 to 2012. NTDs significantly decreased after large-scale supplemental folic acid intervention, while the incidence rate of CHD significantly increased.

Feasibility of constructing a screening-evaluating-intervention system of congenital heart disease in Changzhou city

Objective To investigate the prevalence and the distribution of congenital heart disease(CHD) in Changzhou city.The clinical data of 106 CHD infants were reviewed, so as to provide some evidence for making CHD screening-evaluating-intervention system. Methods All infants(16 070 cases) born in Changzhou Maternal and Child Health Hospital from May 1st 2011 to Apr.30th 2013 were screened for CHD.The infants with CHD were followed up for one year periodically after discharge. Results One hundred and seventeen infants were screened positive, and 106 cases of them were diagnosed as CHD, and the detectable rate was 6.60‰.The top three incidence was VSD (2.18‰, 35/16 070 cases), PDA(1.74‰, 28/16 070 cases) and ASD(1.06‰, 17/16 070 cases). Among them, 81 cases were detected as cardiac souffle, and 48 cases as abnormal pulse oximetry.In 106 cases, 97 cases were followed up and 9 cases did not receive follow-up.The close ratio were higher in ASD, PDA, VSD, which was 76.47%, 64.29%, 62.86%.The size of gap had an effect on close ratio, small gap of VSD, ASD and premature PDA were higher and medium and large gap and full-term infants were lower.Some serious type of CHD infants received operations, and others were still followed up. Conclusion The detectable rate of CHD among infants was identical to the average level of whole country.The follow-up study may improve the quality of the survival of CHD infants, and it is feasible to construct a system of screening-evaluating-intervention systcm of CHD. Key words: Infants, newborn; Congenital heart disease; Screening; Follow-up

Predictors of postnatal complications and congenital cardiac diseases in infants of mothers with pregestational and gestational diabetes.

In this study, we aimed to evaluate the postnatal problems of infants of mothers with pregestational and gestational diabetes and the clinical properties of infants who were found to have congenital cardiac disease. We retrospectively examined the records of 337 newborns who were followed up with a diagnosis of infant of diabetic mother between January 2010 and January 2012 in our Neonatology Unit. The demographic data of the diabetic mothers and their babies, the postnatal problems of the babies of diabetic mothers and congenital heart diseases found on transthoracic echocardiography were examined. The patients were classified as group A, B and C in accordance with the recommendations of The American Congress of Obstetricians and Gynecologists (ACOG) according to the type of diabetes. The most common postnatal problems included hyperbilirubinemia, respiratory distress, hypoglycemia and hypocalcemia. The rate of congenital heart disease was found be 17.3% in group A, 50% in group B and 9% in group C. No correlation was found between congenital heart disease and gender, multiple pregnancy, diabetes type, diet treatment, use of oral antidiabetic drugs and drug usage. A positive significant correlation was found between congenital heart disease and genetic disease, murmur, cyanosis and presence of gestational hypertension. It was shown that use of insulin, genetic disease and presence of gestational diabetes increased the risk of congenital heart disease. In our study, the overall incidence of congenital heart disease was found to be 24% in infants of diabetic mothers. It should be kept in mind that it is important to investigate the infants of mothers with pregestational and gestational diabetes in terms of the risk of congenital heart disease.

Outcome of children [corrected] with heart murmurs referred from general practice to a paediatrician with expertise in cardiology.

Heart murmurs are common in children. The majority are detected incidentally, and congenital heart disease is rare. There are no published United Kingdom guidelines for management of children with murmurs in primary care. Common practice is to refer all children for specialist assessment. To review outcomes of children with heart murmurs who were referred by general practitioners to a clinic conducted by a paediatrician with expertise in cardiology. Design and setting A retrospective review of children referred by general practitioners to a paediatrician with expertise in cardiology. Hospital records of all children under 17 years of age who attended the clinic during 2011 were reviewed. We excluded children previously seen by any cardiology service. There were 313 new primary care referrals, with complete records available for 310 children. Of them, 186 (60%) were referred with a murmur: 154 for an asymptomatic murmur alone, and 32 for a murmur plus additional symptoms or family history of congenital heart disease. All underwent echocardiography. Of the patients, 38 (20%) had congenital heart disease. Younger children were more likely to have congenital heart disease. There was no difference between rates of congenital heart disease in children with or without symptoms or a family history. The finding that a large proportion of children referred by general practitioners with asymptomatic heart murmurs have congenital heart disease supports current referral practice on clinical grounds.

Impact of a standardized training program on midwives' ability to assess fetal heart anatomy by ultrasound.

BackgroundStudies of prenatal detection of congenital heart disease (CHD) in the UK, Italy, and Norway indicate that it should be possible to improve the prenatal detection rate of CHD in Sweden. These studies have shown that training programs, visualization of the outflow tracts and color-Doppler all can help to speed up and improve the detection rate and accuracy. We aimed to introduce a more accurate standardized fetal cardiac ultrasound screening protocol in Sweden.MethodsA novel pedagogical model for training midwives in standardized cardiac imaging was developed, a model using a think-aloud analysis during a pre- and post-course test and a subsequent group reflection. The self-estimated difficulties and knowledge gaps of two experienced and two beginner midwives were identified. A two-day course with mixed lectures, demonstrations and hands-on sessions was followed by a feedback session three months later consisting of an interview and check-up. The long-term effects were tested two years later.ResultsAt the post-course test the self-assessed uncertainty was lower than at the pre-course test. The qualitative evaluation showed that the color Doppler images were difficult to interpret, but the training seems to have improved their ability to use the new technique. The ability to perform the method remained at the new level at follow-up both three months and two years later.ConclusionsOur results indicate that by implementing new imaging modalities and providing hands-on training, uncertainty can be reduced and examination time decreased, but they also show that continuous on-site training with clinical and technical back-up is important.