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Fetus

Poster Session 2

(416) Critical congenital heart disease: Contemporary prenatal screening performance in an Irish perinatology center

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Prenatal detection of critical congenital heart disease (CCHD) optimises neonatal outcome. The objective of this study was to determine the prenatal screening performance of a program instituted in a tertiary-referral perinatology center with a prescribed screening protocol, multi-dimensional training support, senior in-person review of all suspected CCHD cases and extended support for secondary referral services.

Study Design:

A 4-year retrospective cohort study examined all cases of CCHD requiring intervention in the first 4 weeks of life among infants delivered in a perinatology center and its affiliated regional sites. All cases of CCHD that underwent pregnancy termination, died in-utero or in the early neonatal period were also ascertained. The protocolised prenatal screening service included a scan at 18-22 weeks, repeat screening for cases of non-acquisition of defined 4-chamber or outflow tract views and Fetal Medicine review in the event of non-acquisition on 2nd attempt. CCHD was defined as duct-dependency or cardiac abnormality requiring urgent intervention in the first 4 weeks of life. All cases were referred to a single national pediatric cardiac centre. Data sources included dedicated prenatal ultrasound and pediatric cardiology databases, perinatal, neonatal and pediatric chart review.

Results:

From 01/2019 to 12/2022, among a consecutive cohort of 49,950 pregnancies who underwent prenatal screening for congenital heart disease, 104 cases (0.2%) were significant for CCHD, of whom 91% (95/104) were detected in the prenatal period. Aortic coarctation represented 78% (7/9) of CCHD cases first identified in the neonatal period, with 2 additional cases of postnatally-identified pulmonary stenosis. No case of single-ventricle pathology nor of transposition of the great arteries was missed by the prenatal screening program. 

Conclusion:

Prenatal detection of CCHD in a tertiary care unit and its affiliated sites exceeds 91%, with undetected cases limited to outflow tract obstructive lesions that may not be amenable to prenatal detection.