Lower costs of hospital stay for newborns with HLHS after prenatal diagnoses comparing with postnatal diagnoses

Abstract

Hypoplastic Left Heart Syndrome (HLHS) is the most common heart defect in the population of fetuses and majority of Polish women deceided to continue their pregnancies despite prenatal diagnosis. The aim of the study: Are there any differences in newborns with HLHS after prenatal diagnoses and with postnatal diagnoses, operated on in ICZMP (Polish Mother’s Memorial Hospital) in Lodz in the years 2005-2010. Material and Methods: A retrospective analysis of medical records of 155 newborns from the subdivision of Anaesthesiology and Paediatric Intensive Care (ICZMP) in two groups: prenatally diagnosed (n = 87) and without prenatal diagnosis (n = 68). Results: Newborns were born with normal birth weights, in two groups prenatal and postnatal (3109.5 ± 494.8g vs. 3258.6 ± 443.1 g, p = 0.06 ). Most of them (85%) were born on time and in good condition (9-10 points on the Apgar). The surgery was performed earlier in prenatal group (p = 0.0364). The chance of surgery between 6th and 10th day after birth in prenatal group was twice as high as in the group diagnosed after birth (OR = 2.0 [0.9 4.3]). The infant’s average length of stay in the ICU after the first stage of treatment was 8 days and was almost the same in both groups (8,0 [5,0 20,5] vs. 8,0 16,0]; NS). Total mortality was 19.4% and it did not differ in both groups (p = 0.4596). The risk of death in prematurity group was 5x higher than in group of newborns delivered at term (p=0,0073). In prenatal group cardiac surgery was earlier than in group diagnosed after delivery (p=0,0364). Neonates with late surgery had longer hospitalization, compared with early surgery (44 days vs 33 days, p=0,0073). Longer hospital stay means higher hospital cost (for cardiac surgery department circa 3000 zł per 1 patient with HLHS, meaning 90 000 zl per year for 30 patients). Conclusions: 1) The neonatal outcome of newborns with HLHS in ICU, in our center in years 2005-2010, in two groups: after prenatal diagnoses and in postnatal diagnoses, were similar. 2) The main differences were a) an increased risk of death in case of premature delivery (p=0,0073) b) earlier I stage Norwood in prenatal group (p=0,0364) meaning lower costs for single institution, meaning lower costs for the National Health System.