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Prenatal diagnosis and planned peri-partum care as a strategy to improve pre-operative status in neonates with critical CHDs in low-resource settings: a prospective study

Published online by Cambridge University Press:  04 November 2019

Aparna Vijayaraghavan Open the ORCID record for Aparna Vijayaraghavan [Opens in a new window] ,
Abish Sudhakar ,
Karimassery Ramiayar Sundaram ,
Raman Krishna Kumar Open the ORCID record for Raman Krishna Kumar [Opens in a new window]  and
Balu Vaidyanathan
Aparna Vijayaraghavan
Affiliation:
The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
Abish Sudhakar
Affiliation:
The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
Karimassery Ramiayar Sundaram
Affiliation:
Department of Biostatistics, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
Raman Krishna Kumar
Affiliation:
The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
Balu Vaidyanathan*
Affiliation:
The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
*
Author for correspondence: Dr B. Vaidyanathan, Clinical Professor, Pediatric Cardiology Head, Fetal cardiology Division, Amrita Institute of Medical Sciences, Kochi, Kerala 682 041, India. Tel: + 91 484 285 3570; Phone: +91 94958 20684; Fax: +91 484 280 2020; E-mail: [email protected]
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Abstract

Background:

Prenatal diagnosis and planned peri-partum care is an unexplored concept for care of neonates with critical CHDs in low-middle-income countries.

Objective:

To report the impact of prenatal diagnosis on pre-operative status in neonates with critical CHD.

Methods:

Prospective observational study (January 2017–June 2018) in tertiary paediatric cardiac facility in Kerala, India. Neonates (<28 days) with critical CHDs needing cardiac interventions were included. Pre-term infants (<35 weeks) and those without intention to treat were excluded. Patients were grouped into those with prenatal diagnosis and diagnosis after birth. Main outcome measure was pre-operative clinical status.

Results:

Total 119 neonates included; 39 (32.8%) had prenatal diagnosis. Eighty infants (67%) underwent surgery while 32 (27%) needed catheter-based interventions. Pre-operative status was significantly better in prenatal group; California modification of transport risk index of physiological stability (Ca-TRIPS) score: median 6 (0–42) versus 8 (0–64); p < 0.001; pre-operative assessment of cardiac and haemodynamic status (PRACHS) score: median 1 (0–4) versus 3 (0–10), p < 0.001. Age at cardiac procedure was earlier in prenatal group (median 5 (1–26) versus 7 (1–43) days; p = 0.02). Mortality occurred in 12 patients (10%), with 3 post-operative deaths (2.5%). Pre-operative mortality was higher in postnatal group (10% versus 2.6%; p = 0.2) of which seven (6%) died due to suboptimal pre-operative status precluding surgery.

Conclusion:

Prenatal diagnosis and planned peri-partum care had a significant impact on the pre-operative status in neonates with critical CHD in a low-resource setting.

Keywords

Prenatal diagnosispre-operative statusneonatescritical CHDs
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 12 , December 2019 , pp. 1481 - 1488
Copyright
© Cambridge University Press 2019 

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References

Van Der Linde, D, Konings, EEM, Slager, MA, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol 2011; 58: 2241–2247.CrossRefGoogle ScholarPubMed
Saxena, A, Mehta, A, Sharma, M, et al. Birth prevalence of congenital heart disease: a cross-sectional observational study from North India. Ann Pediatr Card 2016; 9: 205–209.CrossRefGoogle ScholarPubMed
Liske, MR, Greely, CS, Law, DJ, et al. Report of the Tennessee task force on screening for newborn infants with critical congenital heart disease. Pediatrics 2006; 118: e1250–e1256.CrossRefGoogle ScholarPubMed
Fadel, SA, Rasaily, R, Aswathi, S, et al. Changes in cause-specific neonatal and 1–59 month child mortality in India from 2000 to 2015: a nationally representative study. Million Death study Collaborators. Lancet 2017. doi:10.1016/S0140-6736(17)32162-1CrossRefGoogle Scholar
Murray, CJL, Vos, T, Lozano, R, et al. Disability- adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010. A systematic analysis for the Global burden of disease study 2010. Lancet 2012; 380: 2197–2223.CrossRefGoogle ScholarPubMed
Kumar, RK, Shrivastava, S. Pediatric heart care in India. Heart 2008; 94: 984–990CrossRefGoogle ScholarPubMed
Gilboa, SM, Salemi, JL, Nembhard, WN, Fixler, DE, Correa, A. Mortality resulting from congenital heart disease among children and adults in the United States, 1999 to 2006. Circulation 2010; 122: 2254–2263.CrossRefGoogle ScholarPubMed
Schultz, AH, Localio, R, Clark, BJ, Ravishankar, C, Videon, N, Kimmel, SE. Epidemiologic features of the presentation of critical congenital heart disease: implications for screening. Pediatrics 2008; 121: 751–757.CrossRefGoogle ScholarPubMed
Wren, C, Reinhardt, Z, Khawaja, K. Twenty-year trends in diagnosis of life-threatening neonatal cardiovascular malformations. Arch Dis Child Fetal Neonatal Ed 2008; 93: F33–F35.CrossRefGoogle ScholarPubMed
Karmegaraj, B, Kappanayil, M, Sudhakar, A, Kumar, RK. Impact of transport on arrival status and outcomes in newborns with heart disease – A Low-Medium income country perspective. Abstract in 7th World Congress of Pediatric Cardiology and Surgery. Cardiol Young 2017; 27. doi:10.1017/S104795111700110X.CrossRefGoogle Scholar
Reddy, NS, Kappanayil, M, Balachandran, R, et al. Preoperative determinants of outcomes of infant heart surgery in a limited-resource setting. Seminars Thoracic Surg 2015; 27: 331–338.Google Scholar
Bakshi, KD, Vaidyanathan, B, Sundaram, KR, et al. Determinants of early outcome after neonatal heart surgery in a developing country. J Thorac Cardiovasc Surg 2007; 134: 765–771.CrossRefGoogle Scholar
Hunter, S, Heads, A, Wyllie, J, Robson, S. Prenatal diagnosis of congenital heart disease in the northern region of England: benefits of a training programme for obstetric sonographers. Heart 2000; 84: 294–298.CrossRefGoogle Scholar
Lytzen, R, Vejlstrup, N, Bjerre, J, et al. Live-born major congenital heart disease in Denmark. Incidence, detection and termination of pregnancy rate from 1996 to 2013. JAMA Cardiol 2018. doi:10.1001/jamacardio.2018.2009.CrossRefGoogle Scholar
Simpson, JM. Impact of fetal echocardiography. Ann Pediatric Card 2009; 2: 41–50.CrossRefGoogle ScholarPubMed
Carvalho, JS. Antenatal diagnosis of critical congenital heart disease. Optimal place of delivery is where appropriate care can be delivered. Arch Dis Child 2016; 101: 505–507.CrossRefGoogle ScholarPubMed
Holland, BJ, Myers, JA, Woods, CR Jr. Prenatal diagnosis of critical congenital heart disease reduces risk of death from cardiovascular compromise prior to planned neonatal cardiac surgery: a meta-analysis. Ultrasound Obstet Gynecol 2015; 45: 631–638.CrossRefGoogle ScholarPubMed
Thakur, V, Dutil, N, Schwartz, SM, Jaeggi, E. Impact of prenatal diagnosis on the management and early outcome of critical duct-dependent cardiac lesions. Cardiol Young 2018; 28: 548–553.CrossRefGoogle ScholarPubMed
Quartermain, MD, Hill, KD, Goldberg, DJ, et al. Prenatal diagnosis influences preoperative status in neonates with congenital heart disease: an analysis of the society of thoracic surgeons congenital heart surgery database. Pediatr Cardiol. 2018. doi:10.1007/s00246-018-1995-4CrossRefGoogle Scholar
Cloete, E, Bloomfield, FH, Sadler, L, de Laat, MWM, Finucane, K, Gentles, TL. Antenatal detection of treatable critical congenital heart disease is associated with lower morbidity and mortality. J Pediatrics 2019; 204: 66–70.CrossRefGoogle ScholarPubMed
Chakraborty, A, Gorla, SR, Swaminathan, S. Impact of prenatal diagnosis of complex congenital heart disease on neonatal and infant morbidity and mortality. Prenat Diagn 2018; 38: 958–963. doi:10.1002/pd.5351.CrossRefGoogle ScholarPubMed
Khoshnood, B, Lelong, N, Houyel, L, et al. EPICARD Study group. Impact of prenatal diagnosis on survival of newborns with four congenital heart defects: a prospective, population-based cohort study in France (the EPICARD Study). BMJ Open 2017; 7: e018285. doi: 10.1136/bmjopen-2017-018285.CrossRefGoogle Scholar
Bah, MNM, Sapian, MH, Jamil, MT, Alias, A, Zahari, N. Survival and associated risk factors for mortality among infants with critical congenital heart defects in a developing country. Pediatr Cardiol 2018. doi:10.1007/s00246-018-1908-6.CrossRefGoogle Scholar
Eckersley, L, Sadler, L, Parry, E, Finucane, K, Gentles, TL. Timing of diagnosis affects mortality in critical congenital heart disease. Arch Dis Child 2015. doi:10.1136/archdischild-2014-307691.CrossRefGoogle Scholar
Jenkins, KJ. Risk adjustment for congenital heart surgery: the RACHS-1 method. Semi Thorac Cardiovasc Surg 2004; 7: 80–84.Google ScholarPubMed
Gould, JB, Danielsen, BH, Bollman, L, Hackel, A, Murphy, B. Estimating the quality of neonatal transport in California. J Perinatol 2013; 33: 964–970.CrossRefGoogle ScholarPubMed
Jenkins, KJ, Casteneda, AR, Cherian, KM, et al. Reducing mortality and infections after congenital heart surgery in the developing world. Pediatrics 2014; 134: e1422–e1430.CrossRefGoogle ScholarPubMed
Carvalho, JS, Allan, LD, Chaoui, R, et al. ISUOG practice guidelines (updated): sonographic screening examination of the fetal heart. Ultrasound Obstet Gynecol 2013; 41: 348–359.CrossRefGoogle Scholar
Mahle, WT, Newburger, JW, Matherne, GP, et al. Role of pulse oximetry in examining newborns for congenital heart disease. A scientific statement from the American Heart Association and American Academy of Paediatrics. Circulation 2009; 120: 447–458.CrossRefGoogle Scholar
Anagnostou, A, Messenger, L, Yates, R, Kelsall, W. Outcome of infants with prenatally diagnosed congenital heart disease delivered outside specialist pediatric cardiac centers. Arch Dis Child Fetal Neonatal Ed 2013; 98: F218–F221.CrossRefGoogle Scholar
National Health Mission – Hridyam for Little Hearts. Retrieved from http://hridyam.in/chd.php. Accessed 1st February, 2019.Google Scholar
Changlani, TD, Jose, A, Sudhakar, A, Rojal, R, Kunjikutty, R, Vaidyanathan, B. Outcomes of infants with prenatally diagnosed congenital heart disease delivered in a pediatric cardiac facility. Indian Pediatr 2015; 52: 852–856.CrossRefGoogle Scholar
Musa, NL, Hjortdal, V, Zheleva, B, et al. The global burden of congenital heart disease. Cardiol Young 2017; 27: S3–S8.CrossRefGoogle Scholar
Solomon, RS, Sasi, T, Sudhakar, A, Kumar, RK, Vaidyanathan, B. Early Neurodevelopmental outcomes after corrective cardiac surgery in Indian infants. Indian Paediatr 2018; 55: 400–404.CrossRefGoogle Scholar
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