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Prenatal diagnosis and planned peri-partum care as a strategy to improve pre-operative status in neonates with critical CHDs in low-resource settings: a prospective study

Published online by Cambridge University Press:  04 November 2019

Aparna Vijayaraghavan
Affiliation:
The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
Abish Sudhakar
Affiliation:
The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
Karimassery Ramiayar Sundaram
Affiliation:
Department of Biostatistics, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
Raman Krishna Kumar
Affiliation:
The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
Balu Vaidyanathan*
Affiliation:
The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
*
Author for correspondence: Dr B. Vaidyanathan, Clinical Professor, Pediatric Cardiology Head, Fetal cardiology Division, Amrita Institute of Medical Sciences, Kochi, Kerala 682 041, India. Tel: + 91 484 285 3570; Phone: +91 94958 20684; Fax: +91 484 280 2020; E-mail: baluvaidyanathan@gmail.com

Abstract

Background:

Prenatal diagnosis and planned peri-partum care is an unexplored concept for care of neonates with critical CHDs in low-middle-income countries.

Objective:

To report the impact of prenatal diagnosis on pre-operative status in neonates with critical CHD.

Methods:

Prospective observational study (January 2017–June 2018) in tertiary paediatric cardiac facility in Kerala, India. Neonates (<28 days) with critical CHDs needing cardiac interventions were included. Pre-term infants (<35 weeks) and those without intention to treat were excluded. Patients were grouped into those with prenatal diagnosis and diagnosis after birth. Main outcome measure was pre-operative clinical status.

Results:

Total 119 neonates included; 39 (32.8%) had prenatal diagnosis. Eighty infants (67%) underwent surgery while 32 (27%) needed catheter-based interventions. Pre-operative status was significantly better in prenatal group; California modification of transport risk index of physiological stability (Ca-TRIPS) score: median 6 (0–42) versus 8 (0–64); p < 0.001; pre-operative assessment of cardiac and haemodynamic status (PRACHS) score: median 1 (0–4) versus 3 (0–10), p < 0.001. Age at cardiac procedure was earlier in prenatal group (median 5 (1–26) versus 7 (1–43) days; p = 0.02). Mortality occurred in 12 patients (10%), with 3 post-operative deaths (2.5%). Pre-operative mortality was higher in postnatal group (10% versus 2.6%; p = 0.2) of which seven (6%) died due to suboptimal pre-operative status precluding surgery.

Conclusion:

Prenatal diagnosis and planned peri-partum care had a significant impact on the pre-operative status in neonates with critical CHD in a low-resource setting.

Type
Original Article
Copyright
© Cambridge University Press 2019 

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Prenatal diagnosis and planned peri-partum care as a strategy to improve pre-operative status in neonates with critical CHDs in low-resource settings: a prospective study
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