title: Is routine preoperative transthoracic echocardiography necessary in newborns with myelomeningocele?
abstract: OBJECTIVE
  Congenital heart disease (CHD) is common in newborns with myelomeningocele. Echocardiography before neonatal back closure has been recommended. Its utility in the era of prenatal diagnosis is unclear.
  
  
  METHODS
  We reviewed all newborns with myelomeningocele evaluated by preoperative echocardiography at our institution over 11 years.
  
  
  RESULTS
  Seventy-six successive newborns were identified. Ninety-one percent were prenatally diagnosed with myelomeningocele. In all, 1% had critical, 12% critical or non-critical and 22% critical, non-critical or possible CHD. The single case of critical CHD was both prenatally diagnosed and clinically identifiable.
  
  
  CONCLUSIONS
  The prevalence of CHD in newborns with myelomeningocele is increased compared with the general population; however, critical disease is uncommon. We propose preoperative echocardiography is unnecessary when the myelomeningocele is prenatally diagnosed, antenatal cardiac screening is complete and normal, and the newborn is clinically well.
authors.affiliation: Division of Cardiology, Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Vernon
authors.affiliation: Division of Developmental Medicine, Department of Pediatrics, Madigan Army Medical Center, Tacoma, WA, USA.|Division of Developmental Medicine, Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: D
authors.initials: D
authors.lastname: Powell
authors.affiliation: Division of Cardiology, Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: A H
authors.initials: AH
authors.lastname: Schultz
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: T D
authors.initials: TD
authors.lastname: Simon
authors.affiliation: Division of Developmental Medicine, Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: D
authors.initials: D
authors.lastname: Doherty
mesh_terms: D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008591:Meningomyelocele / Q000175:diagnosis* / Q000601:surgery*; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000592:standards*; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016216:Ultrasonography, Prenatal; D014481:United States