Outcomes of critical congenital heart disease requiring emergent neonatal cardiac intervention.

OBJECTIVE: The aim of this study was to evaluate outcomes for neonates with critical congenital heart disease (CHD) requiring emergent neonatal cardiac intervention (ENCI). METHODS: Neonates < 30 days of age that underwent ENCI at <48 h of age were retrospectively enrolled over a 2-year period. RESULTS: Forty-seven neonates met inclusion criteria for ENCI comprising nine cardiac defects that underwent 25 catheterizations and 22 cardiothoracic surgeries. The main groups were d-transposition of the great arteries (DTGA) and total anomalous pulmonary venous return (TAPVR). Prenatal detection was 38% overall: higher for single ventricle (86%) and heterotaxy (75%) than for DTGA (28%) or TAPVR (13%). Mortality was 11.1% (2/18) in prenatally diagnosed versus 13.8% (4/29) in postnatally diagnosed neonates (p = 0.86). Prenatal detection was associated with shorter mean hospital stay: 16.8 versus 30.3 days (p = 0.03). Prenatally diagnosed patients had lower preoperative inotropic scores (p = 0.02), less acidosis (pH; p = 0.09), but decreased likelihood of spontaneous labor (p = 0.01), lower gestational age (p = 0.01), and lower birth weight (p = 0.01). CONCLUSIONS: Fewer deaths occurred in neonates with prenatal detection of their critical CHD requiring ENCI. However, there was no statistical difference in survival demonstrated for prenatally diagnosed neonates in this small cohort. Prenatal detection did improve preoperative clinical status and shorten hospital length of stay.

Prenatal diagnosis of congenital heart disease: impact of mode of delivery on neonatal outcome.

OBJECTIVE: We sought to evaluate the impact of mode of delivery (MOD) on early outcome for neonates diagnosed prenatally with major forms of congenital heart disease (CHD). METHODS: We retrospectively studied infants admitted, over a 2-year period, to a single institution for cardiac intervention. Infants were grouped on the basis of timing of diagnosis (prenatal/postnatal) and MOD--planned (induced labor or planned cesarean delivery) versus spontaneous labor. Multivariate logistic regression was used to evaluate independent predictors for MOD and early outcomes. RESULTS: Of 329 patients, 45% received a prenatal diagnosis of CHD. A prenatal diagnosis of CHD increased the likelihood for planned delivery [odds ratio (OR) 2.6, 95% confidence interval (CI) 1.6 to 4.5, p < 0.001]. Newborns prenatally diagnosed with CHD were more likely to have been delivered between 8 am and 6 pm, Monday through Friday (OR 2.3, 95% CI 1.1 to 4.8, p = 0.019). However, MOD had no statistical impact on Apgar score, duration of pre-operative intubation, and survival to surgery or to discharge. The Risk Adjustment for Congenital Heart Surgery 1 surgical mortality score was the only independent predictor of hospital mortality. CONCLUSIONS: In our experience, although a prenatal diagnosis of CHD decreased the likelihood of spontaneous labor, MOD had no demonstrable impact on neonatal outcome.