Prenatal echocardiography – the impact on neonatal management

Congenital heart disease (CHD) results in neonatal morbidity and mortality. Prenatal diagnosis allows preparing an appropriate perinatal and postnatal care. Babies born in low-risk level sites with unexpected CHD may have poorer outcomes. The purpose of this study was to compare results of foetal echocardiography to postnatal findings and assess the impact of antenatal suspicions of CHD on postnatal management. Medical records of mother-infant pairs with CHD admitted to the Neonatal Intensive Care Unit (NICU) of the Medical University of Gdansk from 01.01. to 31.12.2013 were reviewed. We analysed if the defect was detected pre- or postnatally, and if the diagnosis was made by the obstetrician from low-risk level sites (level I) or from a tertiary care centre (level II sonography). The overall incidence of CHD was 68 (3,4%). Critical congenital heart defects (CCHD) were found in 24 neonates (1,2%), 21 were diagnosed prenatally, 3 were transferred from 1st level units. Correlation between prenatal diagnosis made at our centre and postnatal findings was achieved in 47,7%. Accuracy in all prenatal and postnatal findings for both I and II sonography levels was 35,2%. There were major differences in the disproportion of the great vessels and postnatal confirmation of coarctation of the aorta (CoAo) (7,1%). We obtained a high accuracy of prenatal and postnatal findings in detection of lesions such as Tetralogy of Fallot (ToF), transposition of the great arteries (TGA), DORV (double outlet right ventricle) and Critical Pulmonary Stenosis, which require an outflow tract view (92,9% of cases). Conclusions: We confirmed increasing diagnostic rates when the diagnostics is performed at a tertiary care centre. These results are in agreement with literature stating that prenatal detection of CoAo is still challenging. Despite the high rates of misdiagnosis, majority of infants benefited from prenatally diagnosed CCHD