Transport of infants with congenital heart disease: benefits of antenatal diagnosis

Gupta, Neelam; Leven, Louise; Stewart, Michael J.; Cheung, Michael; Patel, Neil

doi:10.1007/s00431-013-2231-0

Cited by 23 publications

(20 citation statements)

References 17 publications

(15 reference statements)

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“…4,9 O DPN permite um melhor aconselhamento parental e ainda um planeamento perinatal adequado, nomeadamente no que diz respeito ao local do parto. Desta forma, o DPN leva a menores taxas de transporte pós-natal e nos casos em que este é necessário, um transporte mais curto e seguro dos recém-nascidos, designadamente com menor recurso a ventilação invasiva e a menores taxas de uso de inotrópi-cos. 15 Um dado positivo que se destaca, é que todos os RN referenciados ao nosso centro que tiveram DPN nasceram num centro terciário, de onde se conclui que a rede de referenciação funciona quando o DPN é realizado.…”

Section: Discussionunclassified

Cardiopatias Congénitas Complexas: Influência do Diagnóstico Pré-Natal

Correia

Fortunato²,

Martins

et al. 2015

Acta Med Port

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Introduction:Complex congenital heart disease is a group of severe conditions. Prenatal diagnosis has implications on morbidity and mortality for most severe conditions. The purpose of this work was to evaluate the influence of prenatal diagnosis and distance of residence and birth place to a reference center, on immediate morbidity and early mortality of complex congenital heart disease. Material and Methods:Retrospective study of complex congenital heart disease patients of our Hospital, born between 2007 and 2012. Results: There were 126 patients born with complex congenital heart disease. In 95%, pregnancy was followed since the first trimester, with prenatal diagnosis in 42%. There was a statistically significant relation between birth place and prenatal diagnosis. Transposition of great arteries was the most frequent complex congenital heart disease (45.2%), followed by pulmonary atresia with ventricular septal defect (17.5%) and hypoplastic left ventricle (9.5%). Eighty-two patients (65.1%) had prostaglandin infusion and 38 (30.2%) were ventilated before an intervention. Surgery took place in the neonatal period in 73%. Actuarial survival rate at 30 days, 12 and 24 months was 85%, 80% and 75%, respectively. There was no statistically significant relation between prenatal diagnosis and mortality. Discussion: Most patients with complex congenital heart disease did not have prenatal diagnosis. All cases with prenatal diagnosis were born in a tertiary center. Prenatal diagnosis did not influence significantly neonatal mortality, as already described in other studies with heterogeneous complex heart disease. Conclusion: prenatal diagnosis of complex congenital heart disease allowed an adequate referral. Most patients with complex congenital heart disease weren't diagnosed prenatally. This data should be considered when planning prenatal diagnosis of congenital heart disease. Keywords: Heart Defects, Congenital; Prenatal Diagnosis. INTRODUÇÃOAs cardiopatias congénitas são as malformações congénitas major mais comuns e constituem o grupo com maior relevância clínica, com uma prevalência de 0,5% a 1% no período neonatal.1-3 Cerca de metade destas cardiopatias são graves e necessitam de intervenção no período neonatal ou nos primeiros anos de vida. 2As cardiopatias congénitas complexas (CCC) constituem um grupo de doenças graves e incluem na sua grande maioria uma alteração do arranjo segmentar, sendo exemplos o síndrome de coração esquerdo hipoplásico (SCEH), transposição das grandes artérias (TGA) e o coração univentricular. De entre as cardiopatias congénitas,

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Section: Discussionunclassified

Cardiopatias Congénitas Complexas: Influência do Diagnóstico Pré-Natal

Correia

Fortunato²,

Martins

et al. 2015

Acta Med Port

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“…Similarly, advances in prenatal diagnosis make for better preparedness and the referral of the deliveries of severely affected pregnancies to tertiary hospitals, where more adequate care can be provided at birth and during the neonatal period. It has been shown, for instance, that prenatal diagnosis of congenital heart defects allows for early preemptive stabilisation, and is associated with improved early clinical status [24]. Improved prenatal diagnosis also must have an impact, in the sense that better detection of CAs in the foetus increases the likelihood of interruption of affected pregnancies.…”

Section: Discussionmentioning

confidence: 99%

A Nationwide Registry-Based Study on Mortality Due to Rare Congenital Anomalies

Alonso-Ferreira

Sánchez-Díaz

Villaverde-Hueso

et al. 2018

IJERPH

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This study aimed to analyse population-based mortality attributed to rare congenital anomalies (CAs) and assess the associated time trends and geographical differences in Spain. Data on CA-related deaths were sourced from annual mortality databases kept by the National Statistics Institute of Spain (1999–2013). Based on the ICD-10, only CAs corresponding to rare diseases definition were included in this study. Annual age-adjusted mortality rates were calculated and time trends were evaluated by joinpoint regression analysis. Geographical differences were assessed using standardised mortality ratios and cluster detection. A total of 13,660 rare-CA-related deaths (53.4% males) were identified in the study period. Annual age-adjusted mortality rates decreased by an average of −5.2% (−5.5% males, −4.8% females, p < 0.001). Geographical analysis showed a higher risk of rare-CA-related mortality in regions largely located in the south of the country. Despite their limitations, mortality statistics are essential and useful tools for enhancing knowledge of rare disease epidemiology and, by extension, for designing and targeting public health actions. Monitoring rare-CA-related mortality in Spain has shown a 15-year decline and geographical differences in the risk of death, all of which might well be taken into account by the health authorities in order to ensure equality and equity, and to adopt appropriate preventive measures.

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“…We identified a subcohort of 243 neonates who underwent 253 cardiac procedures at a median age of 11 days (6,22). The median gestational age for neonates was 38 weeks (32, 39), and the median birthweight was 2900 g (1700, 3450).…”

Section: Neonate Cohort Clinical Characteristicsmentioning

confidence: 99%

Association between preoperative respiratory support and outcomes in paediatric cardiac surgery

et al. 2019

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Background:Preoperative mechanical ventilation is associated with morbidity and mortality following CHD surgery, but prior studies lack a comprehensive analysis of how preoperative respiratory support mode and timing affects outcomes.Methods:We retrospectively collected data on children <18 years of age undergoing cardiac surgery at an academic tertiary care medical centre. Using multivariable regression, we examined the association between modes of preoperative respiratory support (nasal cannula, high-flow nasal cannula/noninvasive ventilation, or invasive mechanical ventilation), escalation of preoperative respiratory support, and invasive mechanical ventilation on the day of surgery for three outcomes: operative mortality, postoperative length of stay, and postoperative complications. We repeated our analysis in a subcohort of neonates.Results:A total of 701 children underwent 800 surgical procedures, and 40% received preoperative respiratory support. Among neonates, 243 patients underwent 253 surgical procedures, and 79% received preoperative respiratory support. In multivariable analysis, all modes of preoperative respiratory support, escalation in preoperative respiratory support, and invasive mechanical ventilation on the day of surgery were associated with increased odds of prolonged length of stay in children and neonates. Children (odds ratio = 3.69, 95% CI 1.2–11.4) and neonates (odds ratio = 8.97, 95% CI 1.31–61.14) on high-flow nasal cannula/noninvasive ventilation had increased odds of operative mortality compared to those on room air.Conclusion:Preoperative respiratory support is associated with prolonged length of stay and mortality following CHD surgery. Knowing how preoperative respiratory support affects outcomes may help guide surgical timing, inform prognostic conversations, and improve risk stratification models.

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Transport of infants with congenital heart disease: benefits of antenatal diagnosis

Abstract: Improved antenatal detection would allow for safer, less resource intense transfers of infants with CHD.

Cited by 23 publications

References 17 publications

Cardiopatias Congénitas Complexas: Influência do Diagnóstico Pré-Natal

Cardiopatias Congénitas Complexas: Influência do Diagnóstico Pré-Natal

A Nationwide Registry-Based Study on Mortality Due to Rare Congenital Anomalies

Association between preoperative respiratory support and outcomes in paediatric cardiac surgery

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