Prenatal echocardiography – the impact on neonatal management

Congenital heart disease (CHD) results in neonatal morbidity and mortality. Prenatal diagnosis allows preparing an appropriate perinatal and postnatal care. Babies born in low-risk level sites with unexpected CHD may have poorer outcomes. The pur-pose of this study was to compare results of foetal echocardiography to postnatal findings and assess the impact of antenatal suspicions of CHD on postnatal manage-ment. Medical records of mother-infant pairs with CHD admitted to the Neonatal Intensive Care Unit (NICU) of the Medi-cal University of Gdansk from 01.01. to 31.12.2013 were reviewed. We analysed if the defect was detected pre- or postnatally, and if the diagnosis was made by the ob-stetrician from low-risk level sites (level I) or from a tertiary care centre (level II so-nography). The overall incidence of CHD was 68 (3,4%). Critical congenital heart de-fects (CCHD) were found in 24 neonates (1,2%), 21 were diagnosed prenatally, 3 were transferred from 1st level units. Correlation between prenatal diagnosis made at our centre and postnatal findings was achieved in 47,7%. Accuracy in all prenatal and postnatal findings for both I and II sonography levels was 35,2%. There were major differences in the dispropor-tion of the great vessels and postnatal confirmation of coarctation of the aorta (CoAo) (7,1%). We obtained a high ac-curacy of prenatal and postnatal findings in detection of lesions such as Tetralogy of Fallot (ToF), transposition of the great ar-teries (TGA), DORV (double outlet right ventricle) and Critical Pulmonary Steno-sis, which require an outflow tract view (92,9% of cases). Conclusions: We con-firmed increasing diagnostic rates when the diagnostics is performed at a tertiary care centre. These results are in agreement with literature stating that prenatal detec-tion of CoAo is still challenging. Despite the high rates of misdiagnosis, ma-jority of infants benefited from prenatally diagnosed CCHD. 

critical congenital heart disease, foetal, neonatal echocardiography, prenatal diagnosis.

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