DOES PRENATAL DIAGNOSIS OF CRITICAL CONGENITAL HEART DISEASE AFFECT THE SHORT TERM OUTCOME, RAMATHIBODI ' S EXPERIENCE
PRATHAPJAI NIMBORIBOONPORN,POOMIPORN KATUNYUWOMG
The Royal College of Pediatricians of Thailand and Pediatric Society of Thailand The Royal College of Pediatricians of Thailand Pediatric Society of Thailand
Background : Prenatal diagnosis of critical congenital heart disease (CCHD) is important. The impact of fetal echocardiography can reducing prevalence of CCHD morbidity during perinatal and postnatal period. Whether the result is applicable to our institution, remain to be proved. Objective: To compare the morbidity and mortality of neonates with prenatally and postnatally diagnosed CCHD admitted to Ramathibodi Hospital during the period from 1st January 2012 to 31st December 2017.
Material : Retrospective study and prospective cohort study of neonates with prenatally and postnatally diagnosed CCHD at Ramathibodi Hospital. All neonates were categorized into two groups; neonates with prenatally and postnatally diagnosed CCHD. The short term outcomes were collected from pre-operative, operative and post-operative period. The mortality and morbidity between two groups were compared.
Results : 110 participants with 33 cases (30%) of prenatally and 77 cases (70%) of postnatally diagnosed CCHD. Preoperative mortality rate was 3.03% and 6.49% of prenatal and postnatal diagnosis group. The prenatal diagnosis of CCHD has significantly reduced the preoperative mortality (p=0.037). Seventy-eight cases (70%) underwent cardiac surgery with no difference in postoperative mortality between two groups (41.18 % vs 32.79%, p=0.417). Three most common types that cause of death were TGA (29.6%), HLHS (18.5%) and coarctation of aorta (14.8%). Mechanical ventilator usage and metabolic acidosis were more frequently in the postnatal group (OR 0.84, 95% CI 0.765-0.992 and P=0.049). Prenatal group had signi?cantly lower preoperative inotropic drugs usage (OR 0.91, 95% CI 0.32-0.95). ECMO was associated with significantly increased the risk of death (HR: 0.116, 95% CI: 0.01-0.98, p=0.048).
Conclusions : Prenatal diagnosis of CCHD could potentially reduce preoperative mortality in the neonates compare to the group without prenatal diagnosis. However, postoperative mortality remained significantly high in both two groups in our institution. Improvement of cardiac surgery and postoperative care could further reduce the mortality of CCHD.