title: The impact of prenatal diagnosis of complex congenital heart disease on neonatal outcomes.
abstract: Prenatal diagnosis of congenital heart disease (CHD) is increasingly common. However, the current impact of prenatal diagnosis on neonatal outcomes is unclear. Between January 2004 and January 2008, a retrospective chart review of infants who underwent surgical repair of CHD before discharge at our institution was conducted. Obstetric and perioperative variables were recorded. Of 439 neonates, 294 (67%) were diagnosed prenatally (PREdx). Infants with PREdx had a lower mean birth weight (3.0 +/- 0.6 vs. 3.1 +/- 0.6 kg, p = 0.002) and gestational age (37.9 +/- 2.1 vs. 38.6 +/- 2.4 wk, p < 0.001) than those with postnatal diagnosis (POSTdx). Severe lesions were more likely to be PREdx: Neonates with single-ventricle (SV) physiology (n = 130 patients [31.2%]) had increased odds of PREdx (n = 113/130, odds ratio [OR] 4.7; 95% confidence interval [CI] 2.7-8.2, p < 0.001). PREdx was associated with decreased preoperative intubation (OR 0.62; 95% CI 0.42-0.95, p = 0.033), administration of antibiotics (OR 0.23; 95% CI 0.15-0.36, p < 0.001), cardiac catheterization (OR 0.54; 95% CI 0.34-0.85, p = 0.01), and emergency surgery (OR 0.18; 95% CI 0.06-0.5, p < 0.001) compared with POSTdx infants. There was no difference in APGAR scores, preoperative pH, day of life of surgery, operative complications, hospital length of stay, or overall mortality in the PREdx versus POSTdx groups, even when controlling for lesion severity. PREdx was not independently associated with neonatal mortality, despite having included more severe cardiac lesions. PREdx was significantly associated with decreased neonatal morbidity in terms of decreased use of preoperative ventilator, administration of antibiotics, cardiac catheterization, and emergency surgery.
authors.affiliation: Division of Cardiology, Department of Pediatrics and the Center for Prenatal Pediatrics, Morgan Stanley Children's Hospital of New York, Columbia University College of Physicians and Surgeons, New York, NY, USA. ap465@columbia.edu
authors.forename: Allison
authors.initials: A
authors.lastname: Levey
authors.forename: Julie S
authors.initials: JS
authors.lastname: Glickstein
authors.forename: Charles S
authors.initials: CS
authors.lastname: Kleinman
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Levasseur
authors.forename: Jonathan
authors.initials: J
authors.lastname: Chen
authors.forename: Welton M
authors.initials: WM
authors.lastname: Gersony
authors.forename: Ismee A
authors.initials: IA
authors.lastname: Williams
mesh_terms: D001724:Birth Weight; D016009:Chi-Square Distribution; D005260:Female; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index