Analysis of a Cohort of Neonates with Severe Congenital Heart Disease Born Outside a Pediatric Cardiology Center: A Cooperation between Perinatology and Pediatric Cardiology

Background: Studies on neonates with congenital heart disease (CHD) receiving pre- and postnatal care in a perinatology unit outside a pediatric cardiology center are limited. Usually, these neonates are born and receive medical care in a cardiology clinic. The perinatology at Munich Hospital Harlaching focusing pediatric cardiology ensures prenatal care through cardiac intervention within 3 months until discharge in cooperation with the German Heart Centre Munich.

Methods: Retrospective single-center cohort study of all neonates with CHD who received medical care at our perinatology in collaboration with the cardiology center from 2018 to 2022. Analysis of mortality, morbidity, and description of clinical parameters.

Results: Analysis of total n = 122 neonates. Prenatal diagnosis by ultrasound n = 115/122 (94.0%). Nine diagnostic groups: univentricular (diagnosis by ultrasound prenatal (pre) n = 30/115, 26.1%, postnatal (post) n = 33/122, 27.1%), systemic outflow tract obstruction (pre n = 29/115, 25.2%, post n = 20/122, 16.4%), transposition of the great arteries (pre n = 14/115, 12.2%, post n = 13/122, 10.7%), left-to-right shunt lesions (pre n = 11/115, 9.6%, post n = 14/122, 11.5%), Fallot’s tetralogy (pre n = 10/115, 8.7%, post n = 9/122, 7.4%), Ebstein´s anomaly (pre n = 6/115, 5.2%, post n = 6/122, 4.9%), heterotaxy (pre n = 5/115, 4.3%, post n = 1/122, 0.8%), arrhythmia (pre n = 1/115, 0.9%, post n = 1/122, 0.9%), other (pre n = 9/115, 7.8%, post n = 10/122, 8.2%). Abruptio n = 5/122 (4.1%), IUFD n = 1/122 (0.8%).Prenatal care of n = 106/121 (87.6%), initial presentation in GA 31+2. Median GA 39+1, median birthweight 3,100 g, median head circumference 34 cm. Vaginal delivery n = 58/115 (50.4%), caesarean section n = 57/115 (49.6%). Bonding n = 60/113 (53.0%). NICU n = 100/116 (86.0%), IMC n = 6/116 (5.0%), maternity unit n = 10/116 (9.0%). Prostaglandin n = 77/116 (66.0%). Transfer to pediatric cardiology or discharge after median 4 days, retransfer after cardiac intervention after median 14 days, final discharge after median 18.5 days. Final discharge from our neonatology n = 73/100 (73.0%). Significant increase of weight at final discharge from our neonatology (mean 449 g, p < 0.01) and of head circumference (mean 1.3 cm, p < 0.0001). Death in total n = 11/107 (10.3%), palliative care at our perinatology n = 2/11 (18.2%), external death n = 9/11 (81.8%). No patient acutely died at our perinatology.

Conclusion: It is safe to deliver and provide medical care to neonates with CHD in a perinatology with cardiology focus but outside a pediatric cardiology. An increased mortality is not to be assumed. Postoperatively, rapid retransfer to the neonatology is possible to ensure thriving.

Publication History

Article published online:
13 February 2024