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Neonatal management and outcomes of prenatally diagnosed CHDs

Published online by Cambridge University Press:  26 May 2016

Myriam Bensemlali ,
Fanny Bajolle ,
Daniela Laux ,
Pauline Parisot ,
Magalie Ladouceur ,
Laurent Fermont ,
Marilyne Lévy ,
Jérôme Le Bidois ,
Francesca Raimondi  and
Yves Ville
...Show all authors
Myriam Bensemlali*
Affiliation:
Hôpital Necker Enfants malades, APHP, Centre de référence Malformations Cardiaques Congénitales Complexes – M3C, Paris, France Université Paris Descartes, Sorbonne Paris Cité, Paris, France
Fanny Bajolle
Affiliation:
Hôpital Necker Enfants malades, APHP, Centre de référence Malformations Cardiaques Congénitales Complexes – M3C, Paris, France
Daniela Laux
Affiliation:
Cardiologie Pédiatrique, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
Pauline Parisot
Affiliation:
Hôpital Necker Enfants malades, APHP, Centre de référence Malformations Cardiaques Congénitales Complexes – M3C, Paris, France Université Paris Descartes, Sorbonne Paris Cité, Paris, France
Magalie Ladouceur
Affiliation:
Hôpital Necker Enfants malades, APHP, Centre de référence Malformations Cardiaques Congénitales Complexes – M3C, Paris, France
Laurent Fermont
Affiliation:
Hôpital Necker Enfants malades, APHP, Centre de référence Malformations Cardiaques Congénitales Complexes – M3C, Paris, France
Marilyne Lévy
Affiliation:
Hôpital Necker Enfants malades, APHP, Centre de référence Malformations Cardiaques Congénitales Complexes – M3C, Paris, France
Jérôme Le Bidois
Affiliation:
Hôpital Necker Enfants malades, APHP, Centre de référence Malformations Cardiaques Congénitales Complexes – M3C, Paris, France
Francesca Raimondi
Affiliation:
Hôpital Necker Enfants malades, APHP, Centre de référence Malformations Cardiaques Congénitales Complexes – M3C, Paris, France
Yves Ville
Affiliation:
Université Paris Descartes, Sorbonne Paris Cité, Paris, France APHP, Maternité, Service de Gynécologie-Obstétrique, Hôpital Necker Enfants malades, Paris, France
Laurent J. Salomon
Affiliation:
Université Paris Descartes, Sorbonne Paris Cité, Paris, France APHP, Maternité, Service de Gynécologie-Obstétrique, Hôpital Necker Enfants malades, Paris, France
Younes Boudjemline
Affiliation:
Hôpital Necker Enfants malades, APHP, Centre de référence Malformations Cardiaques Congénitales Complexes – M3C, Paris, France Université Paris Descartes, Sorbonne Paris Cité, Paris, France
Damien Bonnet
Affiliation:
Hôpital Necker Enfants malades, APHP, Centre de référence Malformations Cardiaques Congénitales Complexes – M3C, Paris, France Université Paris Descartes, Sorbonne Paris Cité, Paris, France
*
Correspondence to: Dr M. Bensemlali, MD, Unité Médico-Chirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de référence Malformations Cardiaques Congénitales Complexes – M3C, Hôpital Necker Enfants Malades, APHP, Université Paris Descartes, Sorbonne Paris Cité, 149 rue de Sèvres, 75015 Paris, France, EU. Tel: + 331 7139 6623; Fax: +331 4449 4340; E-mail: myriam.bensemlali@gmail.com
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Abstract

Objectives

The aim of this study was to determine the probability of intervention at birth after prenatal diagnosis of CHD.

Methods

A 10-year retrospective study including all foetuses with a prenatally diagnosed CHD and those delivered in a tertiary-care cardiac centre between January, 2002 and December, 2011 was carried out. Patients were classified into eight groups according to the anticipated risk of neonatal intervention.

Results

The need for urgent intervention and/or PGE1 infusion within the first 48 hours of life was 47% (n=507/1080): 72% (n=248) for CHD at risk for a Rashkind procedure, 77% (n=72) for CHD with ductal-dependent pulmonary flow, 13% (n=22) for CHD with potentially ductal-dependent pulmonary flow, 94% (n=62) for CHD with ductal-dependent systemic flow, 29% (n=88) for CHD with potentially ductal-dependant systemic flow, 50% (n=4) for total anomalous pulmonary venous connection, and 17% (n=1) for CHD with atrio-ventricular block. In all, 34% of the patients received PGE1 infusion and 21.4% underwent urgent catheter-based or surgical interventions; 10% of patients without anticipated risk (n=10) underwent an early intervention; 6.7% (n=73) of the patients died; and 55% (n=589) had an intervention before discharge from hospital.

Conclusion

Half of the neonates with foetal CHD benefited from an urgent intervention or PGE1 infusion at birth. We recommend scheduled delivery and in utero transfer for transposition of the great arteries, double-outlet right ventricle with sub-pulmonary ventricular septal defect, total anomalous pulmonary venous connection, CHD with atrio-ventricular block with heart rate <50, all ductal-dependant lesions, and CHD with potentially ductal-dependant systemic flow.

Keywords

CHDoutcomein utero transfer
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 2 , March 2017 , pp. 344 - 353
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Copyright
© Cambridge University Press 2016 

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