Delayed diagnosis of congenital heart disease worsens pre-operative condition and outcome of surgery in neonates

Kate L Brown ^1*, Deborah A Ridout ², Aparna Hoskote ¹, Lynda Verhulst ¹, Marco Ricci ¹ and Catherine Bull ¹

¹ Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom
² The Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, United Kingdom

^* To whom correspondence should be addressed. E-mail: brownk{at}gosh.nhs.uk.

Accepted 5 January 2006

Abstract

Objectives: To assess whether the route by which neonatal congenital heart disease is first recognised, influences surgical morbidity and outcome.

Methods: Surgical neonates admitted to a tertiary cardiac unit between March 1999 and February 2002 were retrospectively reviewed with analysis of risk factors for outcome. Three routes to initial recognition of congenital heart disease were compared: antenatal diagnosis, detection on the postnatal ward and presentation after discharge to home. Outcome measures were mortality and duration of peri-operative ventilation.

Results: 286 neonates had cardiac surgery with median duration of ventilation of 101 hours and hospital mortality of 12%. Recognition of congenital heart disease was antenatal in 20%, on the postnatal ward in 55% and followed discharge to home in 25%. Multiple regression analyses, including the cardiac diagnosis, associated problems and other risk factors, indicated that severe cardiovascular compromise on admission to the cardiac unit was significantly related to mortality and prolonged ventilation. Considered in isolation, the route to recognition of heart disease did not influence mortality or ventilation time. However, route to initial recognition did influence patient condition on admission to the cardiac unit. Cardiovascular compromise and end organ dysfunction were least likely when recognition was antenatal and commonest when presentation occurred after discharge to home.

Conclusion: The setting in which neonatal congenital heart disease is first recognised has an impact on pre-operative condition, which in turn influences post-operative progress and survival after surgery. Optimal screening procedures and access to specialist care will improve outcome for cardiac surgical neonates.

Keywords: cardiac surgery, congenital heart disease, neonate, outcome

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Mahle, W. T., Newburger, J. W., Matherne, G. P., Smith, F. C., Hoke, T. R., Koppel, R., Gidding, S. S., Beekman, R. H. III, Grosse, S. D., on behalf of the American Heart Association Congen, (2009). Role of Pulse Oximetry in Examining Newborns for Congenital Heart Disease: A Scientific Statement From the American Heart Association and American Academy of Pediatrics. Circulation 120: 447-458 [Abstract] [Full Text]  
• Mahle, W. T., Newburger, J. W., Matherne, G. P., Smith, F. C., Hoke, T. R., Koppel, R., Gidding, S. S., Beekman, R. H. III, Grosse, S. D., on behalf of the American Heart Association Congen, (2009). Role of Pulse Oximetry in Examining Newborns for Congenital Heart Disease: A Scientific Statement from the AHA and AAP. Pediatrics 124: 823-836 [Abstract] [Full Text]  
• Sklansky, M. S., Berman, D. P., Pruetz, J. D., Chang, R.-K. R. (2009). Prenatal Screening for Major Congenital Heart Disease: Superiority of Outflow Tracts Over the 4-Chamber View. J Ultrasound Med 28: 889-899 [Abstract] [Full Text]  
• Matsui, H., Mellander, M., Roughton, M., Jicinska, H., Gardiner, H. M. (2008). Morphological and Physiological Predictors of Fetal Aortic Coarctation. Circulation 118: 1793-1801 [Abstract] [Full Text]  
• Chang, R.-K. R., Gurvitz, M., Rodriguez, S. (2008). Missed Diagnosis of Critical Congenital Heart Disease. Arch Pediatr Adolesc Med 162: 969-974 [Abstract] [Full Text]  
• Wren, C, Reinhardt, Z, Khawaja, K (2008). Twenty-year trends in diagnosis of life-threatening neonatal cardiovascular malformations. Arch. Dis. Child. Fetal Neonatal Ed. 93: F33-F35 [Abstract] [Full Text]  
• Valmari, P. (2007). Should pulse oximetry be used to screen for congenital heart disease?. Arch. Dis. Child. Fetal Neonatal Ed. 92: F219-F224 [Abstract] [Full Text]