Abstract 16892: Prenatal Diagnosis Influences Preoperative Status in Neonates With Congenital Heart Disease: an Analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD)
Background: 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 the benefits of prenatal diagnosis (PND) in neonates undergoing cardiac surgery. To isolate the impact of a PND on pre-operative morbidity and overcome limitations of previous studies we utilized a large clinical database to assess the effects of PND of CHD on pre-operative status.
Methods: Neonates (<30 days) undergoing heart surgery from 2010-2014 and recorded in the STS-CHSD were included. Multivariable logistic regression was used to evaluate association between PND and a composite measure including nine major preoperative risk factors. Covariates 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 covariates were excluded.
Results: Included were 12,899 neonates from 112 centers. Major preoperative risk factors were present in 34% overall. By univariate analysis, PND was associated with a lower overall prevalence of major preoperative risk factors and a lower prevalence for 6 out of 9 of the individual risk factors (Table). After adjusting for potential confounders, preoperative risk factors were less prevalent among neonates with PND diagnosis 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).
Conclusions: Among neonates with CHD, a PND is associated with significantly lower rates of pre-operative risk factors for cardiac surgery. Further studies are needed to define the association of PND with longer term clinical outcomes.
Author Disclosures: M. Quartermain: None. K.D. Hill: None. D.J. Goldberg: None. J.J. Jacobs: None. M.L. Jacobs: None. S.K. Pasquali: None. G.R. Verghese: None. A. Wallace: None. R.M. Ungerleider: None.
- © 2016 by American Heart Association, Inc.