Detecting Critical Congenital Heart Disease in Nevada

Abstract

Background: We reviewed data on patients born with critical congenital heart disease in the state of Nevada and analyzed detection via prenatal diagnosis versus newborn pulse oximetry screening, location of birth, and gestational age at birth. Methods: We inquired our databases and electronic health records for all patients with critical congenital heart disease born in Nevada between January 2016 and May 2019. Results: We identified 218 live born patients. Of the 218, average gestational age was 38 weeks (±2.2 weeks). Of the 218, 171 (78%) were prenatally diagnosed, 37 (17%) were diagnosed by immediate postnatal signs and symptoms, 8 (4%) had false-negative pulse oximetry screens that resulted in post-hospital discharge presentations, and 2 (1%) had positive pulse oximetry screens. The eight post-hospital discharge presentations included four in extremis, two with extreme cyanosis, and two dying at home. Of the 171 prenatally diagnosed patients, 157 (92%) were born at the Nevada hospital with the congenital cardiac unit. Conclusion: To the best of our knowledge, our results represent the highest statewide, general population prenatal detection of critical congenital heart disease in the United States. Our high prenatal detection rate led to the majority of patients being born at the Nevada facility with the congenital heart unit, limiting intrastate neonatal transports. On average, patients were born at term. Further, in Nevada, state-mandated, universal pulse oximetry screening resulted in more false-negative results than positive results

Isolated vascular rings in the era of high prenatal detection rates: Demographics, diagnosis, risk factors, and outcome

“…We have previously detailed our state-wide approach for the prenatal diagnosis of cardiovascular malformations. [1][2][3][4] However, briefly, the program encompasses ongoing educational programs for general obstetric and specialized perinatal sonographers. General obstetric sonographer training includes a series of half-day didactic lectures that detail the five-axial view fetal echocardiographic screening method.…”

“…Previous reports describe our fetal cardiology program's movement toward universal prenatal diagnosis of critical congenital heart disease (CCHD). [1][2][3][4] In Nevada, improving detection rates for CCHD has enhanced prenatal detection of other cardiovascular malformations, such as vascular rings. 5,6 The literature emphasizes the rarity of vascular rings.…”

Prenatal Detection—The Real Oxygen of Success?

“…In this issue of the journal, Evans and colleagues publish the Nevada state ascertainment of critical congenital heart defects (CCHDs), defined as requiring intervention during the first 30 days after delivery, between January 2016 and May 2019. 1 The strength of this report is that the Children's Heart Center is the sole provider of postnatal cardiac services in Nevada, and their in-house database, combined with external data sources and demographic data from the Center for Disease Control (CDC) in Atlanta, allows linkage of prenatal and postnatal outcomes for comprehensive data collection.…”

“…Evan's paper, among others, guides us on practical steps to change screening policy and practice in response to a strong evidence base. [1][2][3][4][5] Firstly, to take every opportunity to promote best practice such as population screening with swift referral for suspected cardiac abnormality to experienced fetal practitioners in fetal centers, with either an MFM or cardiology background. Where it does not yet exist, consider colocation of fetal cardiology services with MFM to learn from each other and support sonographers better.…”

“…In this issue of the journal, Evans and colleagues publish the Nevada state ascertainment of critical congenital heart defects (CCHDs), defined as requiring intervention during the first 30 days after delivery, between January 2016 and May 2019. 1…”