Impact of Prenatal Diagnosis on the Management and Prognosis of Infants with Congenital Heart Disease- A Retrospective Study

Abstract

Introduction: Prenatal diagnosis is important in outcome of various congenital anomalies in recent times especially in congenital heart diseases. This study would help in recognising the importance of prenatal diagnosis and in understanding the management of newborns with congenital heart diseases. Aim: To evaluate the impact of prenatal diagnosis on the management and prognosis of infants with congenital heart disease. Materials and Methods: This retrospective study was conducted in Department of Paediatrics at Dr. Vasantrao Pawar Medical College, Nashik, Maharshtra, India, from January 2018 to January 2021. The study was performed on newborns who were diagnosed with Congenital Heart Diseases (CHD) during hospitalisation, in an inborn and outborn unit of Neonatal Intensive Care Unit (NICU). The data recorded for requirement of inotropes, ventilation, arterial blood gas analysis and outcome in the form of survival. The babies were classified into Prenatal ECHO (PNE) group and No Prenatal ECHO Available (NPEA) group, based on availability of prenatal Echocardiogram (ECHO) diagnostic report. CHDs were categorised into critical/major and minor. For the comparison of quantitative variables, Unpaired t-test/Mann- Whitney test was used. For the comparison of qualitative variable, Fisher’s-exact test/Chi-square test was used, as necessary. Results: There were 5000 admissions in the inborn and outborn neonatal unit during the study period, of which 159 cases had a diagnosis of CHDs. The PNE group consisted of 61 neonates who had been diagnosed with CHD and the NPEA group consisted of 67 neonates who were not antenatally diagnosed to have CHD. Ionotropic support needed for PNE group (4.5%) was comparatively lesser than NPEA group (14.3%). Need for ventilation was reduced in PNE group (4.5%) as compared to NPEA group (14.3%). Mean for serum lactate and serum bicarbonate was 3.49±2.58 and 16.24±4.31 in PNE group, whereas, it was 5.08±2.79 and 15.12±4.13 in NPEA group on admission in NICU. In management of critical CHDs, 2/31 (6.5%) babies died in PNE group compared to 11/37 (29.7%) in NPEA group (p-value=0.09). Conclusion: Antenatal diagnosis helps in meticulous management of neonates with congenital heart diseases in terms of fewer requirement of inotropes, need of ventilation and improved management. There was no significant difference in outcome in the form of survival.