The significance of an integrated management mode of prenatal diagnosis-postnatal treatment for critical congenital heart disease in newborns

Xiaohui Zhang; Shaoru He; Yumei Liu; Jing Zhong; Yunxia Sun; Manli Zheng; Juan Gui; Ruixi Wang; Bowen Feng; Jianling Mo; Minqiao Jian; Caisheng Liu; Yijing Liang

doi:10.21037/cdt-20-892

The significance of an integrated management mode of prenatal diagnosis-postnatal treatment for critical congenital heart disease in newborns

Cardiovasc Diagn Ther. 2021 Apr;11(2):447-456. doi: 10.21037/cdt-20-892.

Authors

Affiliations

¹ Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
² Department of NICU, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, China.
³ Department of NICU, Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.

Abstract

Background: Congenital heart disease (CHD) is the most common congenital defect in human beings. The purpose of this article is to investigate impact of an integrated management mode of 'prenatal diagnosis-postnatal treatment' on birth, surgery, prognosis and complications associated with critical CHD (CCHD) in newborns.

Methods: A retrospective analysis of the medical records of newborns diagnosed with CCHD were divided into two groups: prenatal diagnosis and postnatal diagnosis. The demographics, clinical characteristics, surgical status, prognosis and complications of the two groups were compared and the differences identified.

Results: Among the 290 newborns with CCHD, 97 (33.4%) were prenatally diagnosed and 193 (66.6%) were postnatally diagnosed. Newborns in the prenatal diagnostic group were hospitalized immediately after birth, whereas the median age of admission was 6.00 (3.00-12.00) days in postnatal diagnostic group, P=0.000. In terms of postnatal symptoms and signs, the incidence of anhelation, cyanosis and cardiac murmur was higher in the postnatal diagnostic group. The rates of preoperative intubation, postoperative open chest exploration and treatment abandonment were higher in the postnatal diagnostic group. The postnatal diagnostic group was more prone to postoperative complications, such as pneumonia and hypoxic-ischemic brain damage. The preoperative mortality [0 (0.0%) vs. 12 (6.2%), P=0.028] in the prenatal diagnostic group was lower than that in the postnatal diagnostic group. And the one-year survival rate of the prenatal diagnostic group was higher (log-rank test P=0.034).

Conclusions: The integrated management mode of prenatal diagnosis-postnatal treatment can improve postnatal symptoms, reduces complications, reduces preoperative mortality and increases one-year survival rates in newborns with CCHD.

Keywords: Fetus; critical congenital heart disease (critical CHD); integrated management; postnatal treatment; prenatal diagnosis.