Outcome in newborns with intervention < 48 hours postpartum in prenatally versus postnatally diagnosed congenital heart disease

A Wolter; H Holtmann; J Degenhardt; A Kawecki; C Enzensberger; O Graupner; C Vorisek; T Kohl; C Yerebakan; M Khalil; R Axt-Fliedner

doi:10.1055/s-0036-1587795

Ultraschall in der Medizin - European Journal of Ultrasound, Inhaltsverzeichnis

Outcome in newborns with intervention < 48 hours postpartum in prenatally versus postnatally diagnosed congenital heart disease

A Wolter ¹, H Holtmann ¹, J Degenhardt ¹, A Kawecki ¹, C Enzensberger ², O Graupner ³, C Vorisek ¹, T Kohl ⁴, C Yerebakan ⁵, M Khalil ⁶, R Axt-Fliedner ¹

¹Universitätsklinikum Gießen und Marburg, Standort Gießen, Abteilung Pränatalmedizin, Gießen, Germany
²Universitätsklinikum Gießen und Marburg, Standort Marburg, Abteilung Pränatalmedizin, Marburg, Germany
³Frauenklinik des Klinikums rechts der Isar der TU München, München, Germany
⁴Universitätsklinikum Gießen und Marburg, Standort Gießen, Deutsches Zentrum für Fetalchirurgie, Gießen, Germany
⁵Universitätsklinikum Gießen und Marburg, Standort Gießen, Abteilung Kinderherzchirurgie, Gießen, Germany
⁶Universitätsklinikum Gießen und Marburg, Standort Gießen, Abteilung Kinderkardiologie, Gießen, Germany

Abstract

Purpose: The aim of this retrospective analysis was to evaluate outcome in neonates requiring intervention within 48 hours postpartum in prenatally and postnatally diagnosed congenital heart disease (CHD).

Material and methods: We evaluated 142 neonates who presented in our centre between 2005 and 05/2015 with surgery or catheter intervention within 48 hours postpartum and compared 30-day survival and perinatal outcome in patients with prenatally versus postnatally diagnosed CHD.

Results: In 135 of 142 neonates we had information about prenatal or postnatal diagnosis. 15 were lost for follow up within 30 days postpartum. In the group with prenatal diagnosis of CHD and intervention within 48h postpartum,the majority had hypoplastic left heart syndrome (HLH) (47.1%), in the group with postnatal diagnosis the majority had transposition of great arteries (d-TGA) (53.8%).

30-day-survival was 78.5% in the group with prenatal diagnosis versus 89.1% in the group with postnatal diagnosis without significant difference. Rate of caesarean section was significantly higher in patients with prenatal diagnosis than postnatal diagnosis (56.7%vs. 33.8%). Patients with postnatal diagnosis needed more often intubation before intervention (32.9% vs. 53.8%), mean umbilical arterial pH was significantly lower (7.29 vs. 7.33) and pre-intervention lactate showed tendency to higher levels than in patients with prenatal diagnosis (34.5 vs. 53.2 mg/dl). There was no difference in length of hospital stay between the prenatally and postnatally diagnosed groups (21.6 vs. 19.5 days).

Conclusion: 30 days survival showed no difference between the two groups. Prenatal diagnosis seems to influence modus of delivery and pH, lactat levels and need for intubation postpartum. Long time follow up is necessary to evaluate differences in survival and outcomes.