Effect of prenatal diagnosis on outcomes in D-transposition of the great arteries.
BACKGROUND
By decreasing preoperative morbidity, prenatal diagnosis could improve neurodevelopmental outcomes in infants with critical congenital heart disease. We explored the impact of prenatal diagnosis on perinatal and perioperative variables and on outcomes at 1 year of age.


METHODS
We analyzed a database of children enrolled in prospective studies on surgical support techniques from 1988 to 2000. Selection criteria included a diagnosis of D-transposition of the great arteries with intact ventricular septum or ventricular septal defect, no extracardiac congenital anomalies, birth weight >2.3 kg, and repair by arterial switch procedure.


RESULTS
Of 346 patients at enrollment, 25 had a prenatal diagnosis, and 321 did not. Children with prenatal diagnosis, compared with those without, had a lower likelihood of birth by spontaneous labor, lower birth weights, lower Apgar 5 scores, a higher rate of preoperative endotracheal intubation, and surgery at a younger age. They tended to have a lower incidence of fetal distress during labor. At 1 year of age, 272 patients were tested with the Psychomotor Development Index and Mental Development Index of the Bayley Scales. Mean z scores were similar in those with and without prenatal diagnosis for both Psychomotor Development Index (-0.92 +/- 0.93 vs -0.88 +/- 1.05) and Mental Development Index (-0.29 +/- 1.13 vs -0.41 +/- 0.93).


CONCLUSIONS
Infants with D-transposition of the great arteries with and without prenatal diagnosis differed with respect to perinatal and perioperative variables, but their development at 1 year of age was similar. Future studies should include a greater number of children with prenatal diagnosis and a variety of congenital heart lesions.
Bartlett
Jodi M
JM
Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
Wypij
David
D
Bellinger
David C
DC
Rappaport
Leonard A
LA
Heffner
Linda J
LJ
Jonas
Richard A
RA
Newburger
Jane W
JW
D002657:Child Development; D016208:Databases, Factual; D004452:Echocardiography; D005500:Follow-Up Studies; D006128:Growth; D006257:Head / Q000033:anatomy & histology; D006801:Humans; D007223:Infant; D009460:Neurologic Examination; D011296:Prenatal Diagnosis; D011446:Prospective Studies; D011597:Psychomotor Performance; D014188:Transposition of Great Vessels / Q000000981:diagnostic imaging* / Q000601:surgery; D016216:Ultrasonography, Prenatal