Prognosis of severe congenital heart diseases: Do we overestimate the impact of prenatal diagnosis?
Abortion, Therapeutic
Cardiac Surgical Procedures
Databases, Factual
Female
Heart Defects, Congenital
/ diagnosis
Hospital Mortality
Humans
Infant
Infant Mortality
Infant, Newborn
Length of Stay
Predictive Value of Tests
Pregnancy
Prenatal Diagnosis
/ methods
Quality of Life
Retrospective Studies
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
Cardiopathie congénitale
Congenital heart disease
Morbidity
Morbidité
Mortality
Mortalité
Paediatrics
Pédiatrie
Ultrasonography
Échographie
Journal
Archives of cardiovascular diseases
ISSN: 1875-2128
Titre abrégé: Arch Cardiovasc Dis
Pays: Netherlands
ID NLM: 101465655
Informations de publication
Date de publication:
Apr 2019
Apr 2019
Historique:
received:
09
09
2018
revised:
12
10
2018
accepted:
12
11
2018
pubmed:
7
2
2019
medline:
14
6
2019
entrez:
7
2
2019
Statut:
ppublish
Résumé
Prenatal diagnosis of congenital heart disease (CHD) is controversial because of unclear benefits in terms of morbidity and mortality, and issues with healthcare costs and organization. To compare, in children with severe CHD, 1-year morbidity and mortality between prenatal and postnatal diagnosis groups. All pregnancies and children aged<1 year with a diagnosis of severe CHD were collected over a 5-year period from our database. Severe CHDs were defined as lethal cases, cases leading to medical termination of pregnancy, or children requiring surgery and/or interventional catheterization and/or hospitalization during their first year of life. The primary endpoint was 1-year mortality rate among live births. Overall, 322 cases of severe CHD were identified; 200 had a prenatal diagnosis and there were 97 terminations of pregnancy. Of the 225 live births, 34 died before the age of 1 year. The 1-year mortality rate was not significantly different between prenatal and postnatal groups (16.7% vs. 13.9%; p=0.13). In the prenatal group, prostaglandin use was more important and precocious, duration of hospitalization stay was longer, extracardiac complications were less common and cardiac surgery was performed more frequently and later. An association with chromosomal or syndromic anomalies was a risk factor for 1-year mortality. Prenatal diagnosis of severe CHD had an impact on the decision regarding termination of pregnancy, but not on the 1-year prognosis among live births. We should now use large multicentre CHD registries to determine the impact of prenatal diagnosis on postnatal management, neurological prognosis and quality of life.
Sections du résumé
BACKGROUND
BACKGROUND
Prenatal diagnosis of congenital heart disease (CHD) is controversial because of unclear benefits in terms of morbidity and mortality, and issues with healthcare costs and organization.
AIM
OBJECTIVE
To compare, in children with severe CHD, 1-year morbidity and mortality between prenatal and postnatal diagnosis groups.
METHODS
METHODS
All pregnancies and children aged<1 year with a diagnosis of severe CHD were collected over a 5-year period from our database. Severe CHDs were defined as lethal cases, cases leading to medical termination of pregnancy, or children requiring surgery and/or interventional catheterization and/or hospitalization during their first year of life. The primary endpoint was 1-year mortality rate among live births.
RESULTS
RESULTS
Overall, 322 cases of severe CHD were identified; 200 had a prenatal diagnosis and there were 97 terminations of pregnancy. Of the 225 live births, 34 died before the age of 1 year. The 1-year mortality rate was not significantly different between prenatal and postnatal groups (16.7% vs. 13.9%; p=0.13). In the prenatal group, prostaglandin use was more important and precocious, duration of hospitalization stay was longer, extracardiac complications were less common and cardiac surgery was performed more frequently and later. An association with chromosomal or syndromic anomalies was a risk factor for 1-year mortality.
CONCLUSIONS
CONCLUSIONS
Prenatal diagnosis of severe CHD had an impact on the decision regarding termination of pregnancy, but not on the 1-year prognosis among live births. We should now use large multicentre CHD registries to determine the impact of prenatal diagnosis on postnatal management, neurological prognosis and quality of life.
Identifiants
pubmed: 30722979
pii: S1875-2136(19)30020-8
doi: 10.1016/j.acvd.2018.11.013
pii:
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
261-269Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 Elsevier Masson SAS. All rights reserved.