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Pediatric Cardiology

, Volume 40, Issue 3, pp 489–496 | Cite as

Prenatal Diagnosis Influences Preoperative Status in Neonates with Congenital Heart Disease: An Analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database

  • Michael D. QuartermainEmail author
  • Kevin D. Hill
  • David J. Goldberg
  • Jeffrey P. Jacobs
  • Marshall L. Jacobs
  • Sara K. Pasquali
  • George R. Verghese
  • Amelia S. Wallace
  • Ross M. Ungerleider
Original Article

Abstract

The early postnatal course for a newborn with critical congenital heart disease (CHD) can be negatively impacted if diagnosis is delayed. Despite this, there continues to be inconsistent evidence regarding potential benefits associated with prenatal diagnosis (PND) in neonates who undergo cardiac surgery. The objective of this study was to better define the impact of a PND on pre-operative morbidity by utilizing a large clinical database. Neonates (< 30 days) undergoing heart surgery from 2010 to 2014 and entered in the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) were included. Multivariable logistic regression was used to evaluate the association between PND and a composite measure including nine major pre-operative risk factors. Co-variates were included to adjust for important patient characteristics (e.g., weight-for-age z-score, genetic syndromes, prematurity), case complexity, and center effects. Centers and patients with excess missing data for relevant co-variates were excluded. Included were 12,899 neonates undergoing surgery at 112 centers. Major pre-operative risk factors were present in 34% overall. By univariate analysis, PND was associated with a lower overall prevalence of major pre-operative risk factors. After adjusting for potential confounders, major pre-operative risk factors were less prevalent among neonates with PND compared to neonates without PND (adjusted OR 0.62, 95% CI 0.57–0.68, p < 0.001). A sensitivity analysis excluding neonates with genetic syndromes, non-cardiac anatomic abnormalities, and prematurity demonstrated similar findings (adjusted OR 0.55, 95% CI 0.49–0.61, p < 0.0001). Among neonates with CHD, prenatal diagnosis is associated with significantly lower rates of pre-operative risk factors for cardiac surgery. Further studies are needed to define association of these pre-operative benefits of a PND with longer term clinical outcomes.

Keywords

Congenital heart disease Prenatal diagnosis Pre-operative outcomes Fetal echocardiography 

Notes

Author Contributions

MDQ, KDH, and RMU conceptualized and designed the study, were involved with data analysis and interpretation, drafted the initial manuscript, and approved the final manuscript as submitted. SKP, DJG, GV, JPJ and MLJ helped conceptualize and design the study, were involved with the data analysis and interpretation, critically reviewed and revised all drafts of the manuscript, and approved the final manuscript as submitted. AW performed the statistical analysis, was involved with study design, reviewed and revised all versions of the manuscript and approved the final manuscript version as submitted.

Funding

This study was funded by the Society of Thoracic Surgeons in the form of data collection and statistical analysis (no grant number available).

Compliance with Ethical Standards

Conflict of interest

Michael Quartermain, Kevin Hill, David Goldberg, Jeffery Jacobs, Marshall Jacobs, Sara Pasquali, Amelia Wallace, George Verghese, and Ross Ungerleider declares that they have no conflict of interest. David Goldberg, receives grants support from Mezzion Pharmaceutical.

Research Involving Human Participants or Animals

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Michael D. Quartermain
    • 1
    • 9
    Email author
  • Kevin D. Hill
    • 2
    • 3
  • David J. Goldberg
    • 1
  • Jeffrey P. Jacobs
    • 4
  • Marshall L. Jacobs
    • 5
  • Sara K. Pasquali
    • 6
  • George R. Verghese
    • 7
  • Amelia S. Wallace
    • 3
  • Ross M. Ungerleider
    • 8
  1. 1.Department of PediatricsUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  2. 2.Duke University Medical CenterDurhamUSA
  3. 3.Duke Clinical Research InstituteDurhamUSA
  4. 4.Department of SurgeryAll Children’s Hospital and Johns Hopkins UniversitySaint PetersburgUSA
  5. 5.Division of Cardiac Surgery, Department of SurgeryJohns Hopkins School of MedicineBaltimoreUSA
  6. 6.University of MichiganAnn ArborUSA
  7. 7.Northwestern University Feinberg School of MedicineChicagoUSA
  8. 8.Driscoll Children’s HospitalCorpus ChristiUSA
  9. 9.Department of PediatricsThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA

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