Comparison of the 1-year survival rate in infants with congenital heart disease diagnosed by prenatal and postnatal ultrasound

Abstract

The impact of prenatal diagnosis on the survival outcome of infants with congenital heart disease (CHD) is still unclear. This study aimed to compare the 1-year survival rate between the prenatally and postnatally diagnosed infants with CHDs. A single-center population-based retrospective cohort study was performed on data from all infants diagnosed with CHD born between January 1998 and December 2017. Among infants with isolated CHDs, the 1-year Kaplan–Meier survival probabilities for prenatal and postnatal diagnosis were estimated. Cox proportional hazard ratios were adjusted for critical CHD (CCHD) status and gestational age. A total of 424 (40 prenatally and 384 postnatally) diagnosed infants with CHDs were analyzed. Compared with non-CCHDs, infants with CCHDs were more likely to be prenatally diagnosed (55.0% vs 18.0%; P < .001). Among the 312 infants with isolated CHDs, the 1-year survival rate for the prenatally diagnosed was significantly lower than postnatally diagnosed (77.1% vs 96.1%; P < .001). For isolated CCHDs, the 1-year survival rate for the prenatally diagnosed was significantly lower than postnatally diagnosed (73.4% vs 90.0%; P < .001). The 1-year survival rate was increased with the increase of age at diagnosis. Among infants with isolated CHDs and CCHDs, the adjusted hazard ratios for 1-year mortality rates for the prenatally versus postnatally diagnosed were 2.554 (95% confidence interval [CI], 1.790, 3.654; P < .001) and 2.538 (95% CI: 1.796, 3.699; P < .001), respectively. Prenatal diagnosis is associated with lower 1-year survival rate for infants with isolated CCHDs. This could probably due to variation in the disease severity among the CCHD subtypes.

Impact of prenatally diagnosed congenital heart defects on outcomes and management

“…Dorfman et al acknowledged the decreasing number of neonates diagnosed with CHD after hospital discharge compared to earlier cohorts (8% down from 43%), however the authors did not find any statistically significant benefit in reduction in perioperative mortality or length of stay associated with prenatal diagnosis 63 . Han et al reported a higher 1‐year mortality rate associated with prenatal detection of complex CHD 55 . The authors hypothesized that the infants with more severe forms of CHD were more likely to be identified with prenatal ultrasound; thus, their poorer outcomes were associated with the severity of disease rather than with the timing of diagnosis.…”

“…63 Han et al reported a higher 1year mortality rate associated with prenatal detection of complex CHD. 55 The authors hypothesized that the infants with more severe forms of CHD were more likely to be identified with prenatal ultrasound; thus, their poorer outcomes were associated with the severity of disease rather than with the timing of diagnosis. Several studies have also reported subgroup analyses based on type of CHD.…”

“…Other studies have defined major, or complex, CHD as lesions that are predicted to result in hemodynamic instability, or which require surgery after birth 54–56 . These are lesions expected to affect important short term outcome measures including acidosis, time to initiation of prostaglandins, preoperative laboratory abnormalities, resuscitative measures such as intubation and ventilation, length of hospital stay, and in‐hospital mortality.…”

“…Other studies have defined major, or complex, CHD as lesions that are predicted to result in hemodynamic instability, or which require surgery after birth. [54][55][56] These are lesions expected to affect important short term outcome measures including acidosis, time to initiation of prostaglandins, preoperative laboratory abnormalities, resuscitative measures such as intubation and ventilation, length of hospital stay, and in-hospital mortality. Particularly given the link between severe metabolic acidosis and subsequent neonatal brain injury, prevention of severe acidosis may play an important role in improving short-and long-term outcomes in infants with CHD.…”

“…62 In contrast to the above, several studies have reported either no difference in overall mortality or survival, or an increased risk of mortality associated with prenatal diagnosis among infants with both isolated CHD and isolated critical CHD. 55,[70][71][72] This increase in mortality associated with prenatal diagnosis may be related to severity of CHD when detected in utero. This hypothesis is supported by other studies reporting similar findings.…”