G423(P) Antenatal detection of critical congenital heart disease and the need for pulse-oximetry - a retrospective audit

Abstract

Aim There is developing consensus regarding routine use of pulse-oximetry. Studies have shown that pulse-oximetry screening can substantially reduce the postnatal diagnostic gap in critical congenital heart disease (CHD)1. Aims of this study were firstly, to determine local antenatal detection rates for critical CHD, and secondly, to benchmark these diagnosis rates as part of the introduction of routine neonatal pulse-oximetry screening in the trust. Methods A retrospective review was performed to identify all infants with an antenatal diagnosis of critical CHD with an estimated date of delivery between March 2009 and March 2013. In addition, local and regional paediatric cardiology databases and the local child death database were reviewed to identify any further cases of critical CHD. Results 31 live births were identified. Data for termination of pregnancy was only available for one year, showing a rate of 39%. Of 31 live births, 23 (74%) were alive at time of study, 5 had died (16%) – 4 of these deaths were picked up at routine screening – and outcome was unknown in 3 cases. 18 cases (58%) were diagnosed antenatally, with a further 6 (19%) diagnosed prior to discharge home from postnatal ward. The remaining 7 (23%) were diagnosed after discharge. TOF, TGA and CoA were the most common lesions (70%). Conclusions Prevalence of critical CHD locally was around 1.3 per 1000 births which is comparable to previously published data2, but the antenatal diagnosis rate was higher (58%) compared to national average (35%, CCAD 2011–12). Despite this, 23% (n = 7) were missed by current antenatal and postnatal screening programmes. Routine postnatal pulse-oximetry would likely have identified 5 of these 7, and the introduction of this in the trust will be monitored and reviewed to assess improvement in diagnostic yield. References Riede FT, et al. Effectiveness of neonatal pulse-oximetry screening for detection of critical congenital heart disease in daily clinical routine -results from a prospective multicenter study. Eur J Pediatr. 2010;169(8):975–81. Wren C, et al. Twenty-year trends in diagnosis of life-threatening neonatal cardiovascular malformations. Arch Dis Child Fetal Neonatal Ed. 2008;92:F219-224