Relation of Prenatal Diagnosis With One-Year Survival Rate for Infants With Congenital Heart Disease

doi:10.1016/j.amjcard.2013.11.065

The American Journal of Cardiology

Volume 113, Issue 6, 15 March 2014, Pages 1041-1044

https://doi.org/10.1016/j.amjcard.2013.11.065 Get rights and content

Prenatal diagnosis of congenital heart defects (CHDs) is increasingly common, but it is still unclear whether it translates to improved postoperative outcomes. We performed a retrospective cohort study of all infants (aged <1 year) who underwent surgery for CHDs from 2006 to 2011 at a single institution. Primary outcomes were in-hospital and 1-year mortality rates. Secondary outcomes were readmission within 30 days of discharge, postoperative length of intensive care unit and hospital stay, unplanned reoperation, and extracorporeal membrane oxygenation use. We used chi-square analyses, Wilcoxon rank-sum tests, Kaplan-Meier survival curves, and adjusted Cox proportional hazards models to compare outcomes. Of the 1,642 patients with CHDs, 539 (33%) were diagnosed prenatally. Patients with prenatal diagnoses were of a younger age and less weight at the time of surgery, had greater Risk Adjustment for Congenital Heart Surgery scores, and were more likely to be white, to have an identified syndrome, or to be born at term. Compared with those diagnosed postnatally, those diagnosed prenatally had a significantly higher unadjusted 1-year mortality rate (11% vs 5.5%, respectively, p = 0.03). Controlling for weight, surgical severity, race, age at surgery, prematurity, and the presence or absence of genetic syndrome, patients with prenatal diagnoses had significantly greater mortality at 1 year (adjusted hazard ratio 1.5, p = 0.03), as well as significantly longer intensive care unit and hospital stays. Infants with CHDs diagnosed prenatally had worse outcomes compared with those diagnosed postnatally. Prenatal diagnosis likely captures patients with more severe phenotypes within given surgical risk categories and even within diagnoses and thus may be an important prognostic factor when counseling families.

Section snippets

Methods

We performed a retrospective cohort study on all infants (aged <1 year at the time of surgery) who underwent surgery for CHDs from January 2006 to December 2011 at Children's Healthcare of Atlanta at Egleston. Patients were divided into 2 exposure groups: prenatal or postnatal diagnosis. If a patient had >1 surgical hospitalization during the study period, data from the first hospitalization were used.

The primary outcome measure was mortality, both in-hospital and at 1 year of age. Secondary

Results

Of the 1,642 patients who met inclusion criteria, 538 (33%) were diagnosed prenatally. Patient characteristics are summarized in Table 1. Infants with prenatal diagnoses were significantly younger and weighed less at the time of surgery than their peers who were diagnosed after birth. African-American and Hispanic patients were more likely to be diagnosed postnatally, whereas white patients were more likely to be prenatally diagnosed. Identified genetic syndromes were significantly more common

Discussion

Contrary to our hypothesis, infants with a prenatal diagnosis of a CHD had worse surgical outcomes compared with those with a postnatal diagnosis, both in terms of 1-year mortality rate and postoperative length of ICU and hospital stay. These differences persisted even after controlling for a variety of factors, including surgical risk category. However, although we could account for differences in severity between surgical risk categories, we could not account for differences in severity within

Disclosures

The authors have no conflicts of interest to disclose.

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Three-dimensional echocardiography and fetal echocardiography uses ultrasound as the backbone in diagnosing and managing congenital heart disease (CHD). Accurate and reliable echocardiographic assessment is critical in clinical decision making. Artificial intelligence technology has the potential to provide automated echocardiographic images to reduce operator dependency and variability in the assessment of CHD using 3D and fetal echocardiography. The application of artificial intelligence in 3D and fetal echocardiography are described and the need for future multicenter collaboration is required to leverage the use of artificial intelligence for 3D and fetal echocardiography in the pediatric population.
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The impact of a prenatal diagnosis (PreND) for congenital heart disease on outcomes after neonatal open heart surgery is undetermined. We hypothesized that PreND has a positive impact on surgical outcomes in terms of immediate postnatal intensive care, which may lead to a decreased risk of persistent shock before surgery.
Among the 949 neonates who underwent open heart surgery between January 2002 and December 2017, 655 patients (69.0%) were diagnosed prenatally (group-PreND) and 294 patients (31.0%) were diagnosed postnatally (group-PostND). Procedural complexity, incidence of postnatal shock (serum lactate >4.0 mmol/L or pH <7.2), hospitalization length of stay, duration of shock, resolution of shock, and in-hospital mortality were compared between the 2 groups.
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Congenital Heart DiseaseRelation of Prenatal Diagnosis With One-Year Survival Rate for Infants With Congenital Heart Disease

Section snippets

Methods

Results

Discussion

Disclosures

Am J Cardiol

Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu

J Thorac Cardiovasc Surg

Prenatal diagnosis of congenital heart disease and birth outcomes

Pediatr Cardiol

Delayed diagnosis of congenital heart disease worsens preoperative condition and outcome of surgery in neonates

Heart

The impact of prenatal diagnosis of complex congenital heart disease on neonatal outcomes

Pediatr Cardiol

Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome

Circulation

Congenital Heart Disease
Relation of Prenatal Diagnosis With One-Year Survival Rate for Infants With Congenital Heart Disease