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Diagnosis of congenital heart disease in an era of universal prenatal ultrasound screening in southwest Ohio

Published online by Cambridge University Press:  10 October 2013

Priya Sekar*
Affiliation:
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Division of Pediatric Cardiology, The Heart Institute, Cincinnati, Ohio, United States of America Department of Pediatrics, Division of Pediatric Cardiology, The Johns Hopkins Hospital, Baltimore, Maryland, United States of America
Haleh C. Heydarian
Affiliation:
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Division of Pediatric Cardiology, The Heart Institute, Cincinnati, Ohio, United States of America
James F. Cnota
Affiliation:
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Division of Pediatric Cardiology, The Heart Institute, Cincinnati, Ohio, United States of America
Lisa K. Hornberger
Affiliation:
Departments of Pediatrics, Division of Pediatric Cardiology and Obstetrics and Gynecology, Fetal & Neonatal Cardiology Program, University of Alberta, Edmonton, Alberta, Canada
Erik C. Michelfelder
Affiliation:
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Division of Pediatric Cardiology, The Heart Institute, Cincinnati, Ohio, United States of America
*
Correspondence to: Dr P. Sekar, MD MPH, Department of Pediatrics, Division of Pediatric Cardiology, Bloomberg Children's Center, Johns Hopkins Hospital, M2303, 1800 Orleans Street, Baltimore, MD 21287, United States of America. Tel: +443 682 0529; Fax: +410 955 0897; E-mail: psekar1@jhmi.edu

Abstract

Objectives

Diagnostic ultrasound is widespread in obstetric practice, yet many babies with major congenital heart disease remain undiagnosed. Factors affecting prenatal diagnosis of major congenital heart disease are not well understood. This study aims to document prenatal detection rates for major congenital heart disease in the Greater Cincinnati area, and identify factors associated with lack of prenatal diagnosis.

Methods

All living infants diagnosed with major congenital heart disease by 4 months of age at our centre were prospectively identified. Prenatal care data were obtained by parent interview. Neonatal records were reviewed for postnatal data. Obstetricians were contacted for diagnostic ultrasound data.

Results

A total of 100 infants met the inclusion criteria. In all, 95 infants were analysed, of whom 94 were offered diagnostic ultrasound. In all, 41 had a prenatal diagnosis of major congenital heart disease. The rate of prenatal detection varied by cardiac lesion, with aortic arch abnormalities, semilunar valve abnormalities, and venous anomalies going undetected in this sample. Among subjects without prenatal detection, the highest proportion consisted of those having Level 1 diagnostic ultrasound only (66%). Prenatal detection was not significantly influenced by maternal race, education level, income, or insurance type.

Conclusions

Despite nearly universal diagnostic ultrasound, detection rates of major congenital heart disease remain low in southwest Ohio. An educational outreach programme including outflow tract sweeps for community-level obstetrical personnel may improve detection rates.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2013 

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