Effectiveness of Prenatal Screening for Congenital Heart Disease: Assessment in a Jurisdiction With Universal Access to Health Care

Abstract Background Neonates with certain forms of severe congenital heart disease (CHD) diagnosed prenatally might have better outcomes in comparison with those diagnosed after birth. The proportion of prenatally detected neonates with severe CHD and the effect of prenatal diagnosis on clinical out...

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Bibliographic Details
Published in:Canadian journal of cardiology 2013-07, Vol.29 (7), p.879-885
Main Authors: Trines, Jean, RN, RDCS, MSc, Fruitman, Deborah, MD, Zuo, Kevin J, Smallhorn, Jeffrey F., MD, Hornberger, Lisa K., MD, Mackie, Andrew S., MD, SM
Format: Article
Language:English
Subjects:
Abortion, Induced - statistics & numerical data
Alberta
Cardiovascular
Female
Health Services Accessibility
Heart Defects, Congenital - diagnosis
Heart Defects, Congenital - surgery
Humans
Infant
Infant, Newborn
Pregnancy
Prenatal Diagnosis - statistics & numerical data
Retrospective Studies
Risk Factors
State Medicine
Surveys and Questionnaires
Treatment Outcome
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Summary:Abstract Background Neonates with certain forms of severe congenital heart disease (CHD) diagnosed prenatally might have better outcomes in comparison with those diagnosed after birth. The proportion of prenatally detected neonates with severe CHD and the effect of prenatal diagnosis on clinical outcomes have not been previously investigated in Canada. Methods We retrospectively studied infants in Alberta, Canada, who required surgical or catheter intervention for CHD at younger than 1 year of age, between January 2007 and December 2010, and pregnancy terminations affected by CHD. Results Of the 374 subjects identified (327 infants, 47 pregnancies with termination), 188 (50%) were detected prenatally. Failure of prenatal diagnosis was associated with anomalies not involving the 4-chamber view on ultrasound (odds ratio, 1.86; 95% confidence interval, 1.48-2.35; P < 0.001) and region of residence ( P  = 0.04). Prenatal detection was associated with fewer days to hospital admission ( P < 0.001), fewer days to surgery ( P  = 0.003), and greater use of prostaglandins ( P  = 0.001). Infants diagnosed prenatally who underwent surgery within 15 days of age had higher preductal O2 saturations ( P  = 0.04), fewer days to admission ( P  = 0.03), and less frequently required preoperative intubation ( P  = 0.004), and inotropes ( P  = 0.001). Pregnancy termination occurred among 49% of fetuses detected before 24 weeks' gestation. Conclusions Only 50% of fetuses and/or neonates with severe CHD managed in Alberta have a prenatal diagnosis. The likelihood of prenatal detection is influenced by the status of the 4-chamber view on ultrasound and the region of maternal residence indicating heterogeneous access to fetal echocardiography within Alberta. Prenatal detection might improve clinical outcomes for neonates with severe CHD.
ISSN:0828-282X
1916-7075
DOI:10.1016/j.cjca.2013.04.028