Skip to main content

Advertisement

SpringerLink
Log in

Fetal Diagnosis is Associated with Improved Perioperative Condition of Neonates Requiring Surgical Intervention for Coarctation

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

To define the relative importance of fetal diagnosis and comorbidities in severity of preoperative compromise, outcomes and hospitalization in neonatal coarctation of the aorta (CoA). Retrospective comparison of preoperative condition and postoperative course of neonates prenatally (PreDx n = 48) or postnatally diagnosed (PostDx n = 67) with CoA. Congenital and non-congenital comorbidities were adjusted for. Postnatal diagnosis was associated with preoperative mortality (n = 2), and severe acidosis (lactate > 5 mM or pH < 7.20) on multivariate analysis (OR 4.2 (1.3–14.4, p = 0.02), with extracardiac congenital anomalies also a risk factor (OR 3.2 (1.03–10, p = 0.044). Median age at operation was delayed in the PostDx group (PreDx 6.5 days (IQR 4–9) vs PostDx 10 days (IQR 6–17)). Only comorbid left heart disease and extracardiac congenital anomalies were associated with prolonged total length of hospital stay. Prenatal diagnosis is the major adjustable risk factor affecting preoperative condition in critical CoA but does not reduce length of stay.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

Data are available on appropriate request from corresponding author.

References

  1. Eckersley L, Sadler L, Parry E, Finucane K, Gentles TL (2016) Timing of diagnosis affects mortality in critical congenital heart disease. Arch Dis Child 101:516–520

    Article  Google Scholar 

  2. Mellander M, Sunnegardh J (2006) Failure to diagnose critical heart malformations in newborns before discharge: an increasing problem? Acta Paediatr 95:407–413

    Article  Google Scholar 

  3. Wren C, Reinhardt Z, Khawaja K (2008) Twenty-year trends in diagnosis of life-threatening neonatal cardiovascular malformations. Arch Dis Child Fetal Neonatal Ed 93:F33-35

    Article  CAS  Google Scholar 

  4. Oster ME, Lee KA, Honein MA, Riehle-Colarusso T, Shin M (2013) Correa A temporal trends in survival among infants with critical congenital heart defects. Pediatrics 131:1502–1508

    Article  Google Scholar 

  5. Eckersley L, Houshmandi M, Hornberger LK (2016) Improving rate of fetal diagnosis of Coarctation of the Aorta in Alberta. Does it relate to obstetric screening guidelines? Can J Cardiol 32:S132

    Article  Google Scholar 

  6. Maitland K, Kiguli S, Opoka RO, Engoru C, Olupot-Olupot P, Akech SO, Nyeko R, Mtove G, Reyburn H, Lang T, Brent B, Evans JA, Tibenderana JK, Crawley J, Russell EC, Levin M, Babiker AG, Gibb DM (2011) Mortality after fluid bolus in African children with severe infection. N Engl J Med 364:2483–2495

    Article  CAS  Google Scholar 

  7. Quartermain MD, Hill KD, Goldberg DJ, Jacobs JP, Jacobs ML, Pasquali SK, Verghese GR, Wallace AS, Ungerleider RM (2019) Prenatal diagnosis influences preoperative status in neonates with congenital heart disease: an analysis of the society of thoracic surgeons congenital heart surgery database. Pediatr Cardiol 40:489–496

    Article  Google Scholar 

  8. Durand I, Deverriere G, Thill C, Lety AS, Parrod C, David N, Barre E, Hazelzet T (2015) Prenatal detection of coarctation of the aorta in a non-selected population: a prospective analysis of 10 years of experience. Pediatr Cardiol 36:1248–1254

    Article  CAS  Google Scholar 

  9. Gomez-Montes E, Herraiz I, Mendoza A, Escribano D, Galindo A (2013) Prediction of coarctation of the aorta in the second half of pregnancy. Ultrasound Obstet Gynecol 41:298–305

    Article  CAS  Google Scholar 

  10. Head CE, Jowett VC, Sharland GK, Simpson JM (2005) Timing of presentation and postnatal outcome of infants suspected of having coarctation of the aorta during fetal life. Heart 91:1070–1074

    Article  CAS  Google Scholar 

  11. Franklin O, Burch M, Manning N, Sleeman K, Gould S, Archer N (2002) Prenatal diagnosis of coarctation of the aorta improves survival and reduces morbidity. Heart 87:67–69

    Article  CAS  Google Scholar 

  12. Slodki M, Rizzo G, Augustyniak A, Seligman NS, Zych-Krekora K, Respondek-Liberska M, International Prenatal Cardiology Collaboration G (2020) Retrospective cohort study of prenatally and postnatally diagnosed coarctation of the aorta (CoA): prenatal diagnosis improve neonatal outcome in severe CoA. J Matern Fetal Neonatal Med 33:947–951

    Article  Google Scholar 

  13. Khoshnood B, Lelong N, Houyel L, Bonnet D, Ballon M, Jouannic JM, Goffinet F (2017) Impact of prenatal diagnosis on survival of newborns with four congenital heart defects: a prospective, population-based cohort study in France (the EPICARD study). BMJ Open 7:018285

    Article  Google Scholar 

  14. Paladini D, Volpe P, Russo MG, Vassallo M, Sclavo G, Gentile M (2004) Aortic coarctation: prognostic indicators of survival in the fetus. Heart 90:1348–1349

    Article  CAS  Google Scholar 

  15. Levey A, Glickstein JS, Kleinman CS, Levasseur SM, Chen J, Gersony WM, Williams IA (2010) The impact of prenatal diagnosis of complex congenital heart disease on neonatal outcomes. Pediatr Cardiol 31:587–597

    Article  Google Scholar 

  16. Tworetzky W, McElhinney DB, Reddy VM, Brook MM, Hanley FL, Silverman NH (2001) Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome. Circulation 103:1269–1273

    Article  CAS  Google Scholar 

  17. Eapen RS, Rowland DG, Franklin WH (1998) Effect of prenatal diagnosis of critical left heart obstruction on perinatal morbidity and mortality. Am J Perinatol 15:237–242

    Article  CAS  Google Scholar 

  18. Satomi G, Yasukochi S, Shimizu T, Takigiku K, Ishii T (1999) Has fetal echocardiography improved the prognosis of congenital heart disease? Comparison of patients with hypoplastic left heart syndrome with and without prenatal diagnosis. Pediatr Int 41:728–732

    Article  CAS  Google Scholar 

  19. Verheijen PM, Lisowski LA, Plantinga RF, Hitchcock JF, Bennink GB, Stoutenbeek P, Meijboom EJ (2003) Prenatal diagnosis of the fetus with hypoplastic left heart syndrome management and outcome. Herz 28:250–256

    Article  Google Scholar 

  20. Bonnet D, Coltri A, Butera G, Fermont L, Le Bidois J, Kachaner J, Sidi D (1999) Detection of transposition of the great arteries in fetuses reduces neonatal morbidity and mortality. Circulation 99:916–918

    Article  CAS  Google Scholar 

  21. Verheijen PM, Lisowski LA, Wassink S, Visser GH, Meijboom EJ (2010) Preoperative acidosis and infant development following surgery for congenital heart disease. Herz 35:358–363

    Article  CAS  Google Scholar 

  22. Duke T, Butt W, South M, Karl TR (1997) Early markers of major adverse events in children after cardiac operations. J Thorac Cardiovasc Surg 114:1042–1052

    Article  CAS  Google Scholar 

  23. Cheung PY, Chui N, Joffe AR, Rebeyka IM, Robertson CM (2005) Postoperative lactate concentrations predict the outcome of infants aged 6 weeks or less after intracardiac surgery: a cohort follow-up to 18 months. J Thorac Cardiovasc Surg 130:837–843

    Article  Google Scholar 

  24. Atallah J, Dinu IA, Joffe AR, Robertson CM, Sauve RS, Dyck JD, Ross DB, Rebeyka IM (2008) Two-year survival and mental and psychomotor outcomes after the Norwood procedure: an analysis of the modified Blalock-Taussig shunt and right ventricle-to-pulmonary artery shunt surgical eras. Circulation 118:1410–1418

    Article  Google Scholar 

  25. Gunn JK, Beca J, Hunt RW, Goldsworthy M, Brizard CP, Finucane K, Donath S, Shekerdemian LS (2016) Perioperative risk factors for impaired neurodevelopment after cardiac surgery in early infancy. Arch Dis Child 101:1010–1016

    Article  Google Scholar 

  26. Gaynor JW, Gerdes M, Nord AS, Bernbaum J, Zackai E, Wernovsky G, Clancy RR, Heagerty PJ, Solot CB, McDonald-McGinn D, Jarvik GP (2010) Is cardiac diagnosis a predictor of neurodevelopmental outcome after cardiac surgery in infancy? J Thorac Cardiovasc Surg 140:1230–1237

    Article  Google Scholar 

  27. Gaynor JW, Stopp C, Wypij D, Andropoulos DB, Atallah J, Atz AM, Beca J, Donofrio MT, Duncan K, Ghanayem NS, Goldberg CS, Hovels-Gurich H, Ichida F, Jacobs JP, Justo R, Latal B, Li JS, Mahle WT, McQuillen PS, Menon SC, Pemberton VL, Pike NA, Pizarro C, Shekerdemian LS, Synnes A, Williams I, Bellinger DC, Newburger JW (2015) Neurodevelopmental outcomes after cardiac surgery in infancy. Pediatrics 135:816–825

    Article  Google Scholar 

  28. Lannering K, Bartos M, Mellander M (2015) Late diagnosis of coarctation despite prenatal ultrasound and postnatal pulse oximetry. Pediatrics 136:e406-412

    Article  Google Scholar 

Download references

Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada

    Mohammad Mehdi Houshmandi, Luke Eckersley & Lisa K. Hornberger

  2. Department of Obstetrics & Gynecology, Women’s & Children’s Health Research Institute, University of Alberta, Edmonton, AB, Canada

    Lisa K. Hornberger

  3. Division of Cardiology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada

    Deborah Fruitman, Lindsay Mills & Alyssa Power

  4. Pediatric Cardiology 4C2, Stollery Children’s Hospital, 8440 112th Street, Edmonton, AB, T6G2B7, Canada

    Luke Eckersley & Lisa K. Hornberger

Authors
  1. Mohammad Mehdi Houshmandi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luke Eckersley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Deborah Fruitman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lindsay Mills
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alyssa Power
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lisa K. Hornberger
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Drs Hornberger, Houshmandi and Eckersley contributed to the study conception and design. Material preparation, data collection and analysis were performed by Drs Mehdi Houshmandi, Luke Eckersley, Alyssa Power, Deborah Fruitman and Lyndsay Mills. The first draft of the manuscript was written by Mehdi Houshmandi and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Luke Eckersley.

Ethics declarations

Conflict of Interest

No conflicts of interest of competing interests exist for any authors.

Ethical Approval

Approved by the relevant ethics committees of the University of Alberta and University of Calgary. Consent to participate was waived.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Houshmandi, M.M., Eckersley, L., Fruitman, D. et al. Fetal Diagnosis is Associated with Improved Perioperative Condition of Neonates Requiring Surgical Intervention for Coarctation. Pediatr Cardiol 42, 1504–1511 (2021). https://doi.org/10.1007/s00246-021-02634-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-021-02634-w

Keywords

Search

Navigation