Clinical relevance of fetal hemodynamic monitoring: Perinatal implications

Pruetz, Jay D.; Votava‐Smith, Jodie K.; Miller, David A.

doi:10.1016/j.siny.2015.03.007

Cited by 11 publications

(3 citation statements)

References 78 publications

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“…We used a consecutive sampling of our FMC RedCap database over a three-year period to enroll pregnant women with a prenatal diagnosis of CHD with assigned ENCI classification of 1 to 4 based on previously published criteria (Table 1) [8,13]. All patients had a complete fetal echocardiogram evaluation at the FMC or CHLA fetal cardiology clinic [9]. If a patient had multiple fetal echocardiograms and/or ENCI levels, then the one closest to delivery was used for analysis.…”

Section: Discussionmentioning

confidence: 99%

“…This is because the fetal echocardiographic features of the atrial septum, foramen ovale, pulmonary venous Doppler, and ductus arteriosus used to predict RAS have low sensitivities and specificities [17]. Until fetal echocardiography markers for predicting RAS in DTGA are more predictive of neonatal compromise, we anticipate a degree of over-assignment (or levelling up) to the ENCI level 4 category in order to prevent potential serious perinatal complications and preoperative morbidities [8,9,12]. PGE administration after birth was started in 30% of lower ENCI level cases without prenatal recommendation.…”

Section: Discussionmentioning

confidence: 99%

“…Prenatal risk stratification in CHD is based on fetal echocardiography findings for which several systems are currently in use and/or are being actively studied [8][9][10][11][12]. At our own institution a method of risk stratification was developed and implemented for prenatally diagnosed CHD to stratify their risk for requiring emergent neonatal cardiac intervention (ENCI), incorporating a four-tier classification system and coordinat-ed perinatal care plan (Table 1) [2].…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of implementing cardiac risk stratification and perinatal care recommendations for prenatally diagnosed congenital heart disease

Harbison¹,

Chen²,

Shepherd³

et al. 2020

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Introduction: Prenatal diagnosis of congenital heart disease (CHD) can best achieve decreases in perinatal mortality and improvements in preoperative clinical status when combined with risk stratification and active perinatal management. This study assessed implementation of a four-tier risk classification system for prenatally diagnosed CHD based on the need for emergent neonatal cardiac intervention (ENCI), each with specific perinatal care recommendations. Material and methods: Prenatally diagnosed fetuses with CHD were risk stratified, and fetal, perinatal and postnatal data were collected with the primary aim to assess risk stratification accuracy. Secondary aims assessed adherence to perinatal management recommendations and evaluation of outcomes compared to a non-risk stratified historical cohort. Results: The study cohort comprised 84 patients prenatally diagnosed with CHD with assigned ENCI level. This included ENCI level 1 (n = 4), level 2 (n = 16), level 3 (n = 50), and level 4 (n = 14). Cardiac intervention was performed emergently in 8 cases (9.5%), non-emergently in neonates in 56 cases (67%), and before one year of age in an additional 15 cases (18%). Our classification system correctly risk stratified 90.4% (76/84) of infants with CHD based on their need for neonatal cardiac intervention. No ENCI level 1 or 2 risk stratified infants required neonatal intervention, and only one of the 50 ENCI level 3 cases required an unanticipated ENCI. Thus, the ENCI classification system correctly identified 98.5% (69/70) of patients who did not require emergent neonatal cardiac intervention in the first 48 hours of life. For perinatal management recommendations, the delivery notifications were appropriately sent 94% of the time, neonatology was present for 99% of recommended deliveries, and PGE was started according to recommendations in 93% (53/57) of ENCI level 3 and 4 cases. The ENCI cohort (2012-2014) compared to an earlier non-risk stratified cohort of 146 patients (2008-2011) showed no difference in survival (p = 0.66) or hospital length of stay (p = 0.19). Conclusions: Implementation of our prenatal risk stratification system accurately predicted the need for emergent neonatal cardiac intervention, and adherence to perinatal management recommendations was high.

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Section: Discussionmentioning

confidence: 99%