Use of fetal tele-echo at small regional hospitals increases the rate of prenatal diagnosis of congenital heart disease.
Journal
Prenatal diagnosis
ISSN: 1097-0223
Titre abrégé: Prenat Diagn
Pays: England
ID NLM: 8106540
Informations de publication
Date de publication:
08 2022
08 2022
Historique:
revised:
27
02
2022
received:
19
10
2021
accepted:
19
05
2022
pubmed:
16
6
2022
medline:
23
8
2022
entrez:
15
6
2022
Statut:
ppublish
Résumé
To improve the rate of prenatal diagnosis of Congenital heart disease (CHD) in Kentucky, four fetal tele-echocardiography sites were established at regional hospitals in Kentucky: Ashland in 2011, Paducah in 2014, Lexington in 2014, and Owensboro in 2016. A 13-year retrospective review of medical records at Norton Children's Hospital was performed to identify patients with CHD who had cardiac surgery or intervention prior to one year of age. The rate of prenatal diagnosis prior to establishing any fetal tele-echocardiography sites was compared to the rate of prenatal diagnosis after the sites were established. Independent t-tests were used to determine if there was a statistically significant increase in the rate of prenatal diagnosis. 1287 patients had cardiac surgery or cath lab intervention prior to one year of age at our institution from June 2005 to December 2018 and were included in the analysis. Seventeen patients were excluded due to incomplete medical records. The rate of prenatal diagnosis prior to the implementation of the first fetal tele-echocardiography site was 13.8% and after the sites were established, the prenatal diagnosis rate was 39.7% (p < 0.01). Increasing the number of fetal tele-echocardiography sites at small regional hospitals in Kentucky was associated with a statistically significant increase in the rate of prenatal diagnosis for patients less than 1 year of age who had cardiac surgery or cath lab intervention at Norton Children's Hospital in Louisville. Fetal tele-echocardiography is an effective method to improve the rate of prenatal diagnosis in regions served by small regional hospitals with limited access to fetal echocardiography.
Sections du résumé
BACKGROUND
To improve the rate of prenatal diagnosis of Congenital heart disease (CHD) in Kentucky, four fetal tele-echocardiography sites were established at regional hospitals in Kentucky: Ashland in 2011, Paducah in 2014, Lexington in 2014, and Owensboro in 2016.
METHODS
A 13-year retrospective review of medical records at Norton Children's Hospital was performed to identify patients with CHD who had cardiac surgery or intervention prior to one year of age. The rate of prenatal diagnosis prior to establishing any fetal tele-echocardiography sites was compared to the rate of prenatal diagnosis after the sites were established. Independent t-tests were used to determine if there was a statistically significant increase in the rate of prenatal diagnosis.
RESULTS
1287 patients had cardiac surgery or cath lab intervention prior to one year of age at our institution from June 2005 to December 2018 and were included in the analysis. Seventeen patients were excluded due to incomplete medical records. The rate of prenatal diagnosis prior to the implementation of the first fetal tele-echocardiography site was 13.8% and after the sites were established, the prenatal diagnosis rate was 39.7% (p < 0.01).
CONCLUSION
Increasing the number of fetal tele-echocardiography sites at small regional hospitals in Kentucky was associated with a statistically significant increase in the rate of prenatal diagnosis for patients less than 1 year of age who had cardiac surgery or cath lab intervention at Norton Children's Hospital in Louisville. Fetal tele-echocardiography is an effective method to improve the rate of prenatal diagnosis in regions served by small regional hospitals with limited access to fetal echocardiography.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1120-1132Informations de copyright
© 2022 John Wiley & Sons Ltd.
Références
Friedberg MW, Hussey PS, Schneider EC. Primary care: a critical review of the evidence on quality and costs of health care. Health Aff. 2010;29(5):766-772.
Mahle WT, Clancy RR, McGaurn SP, Goin JE, Clark BJ. Impact of prenatal diagnosis on survival and early neurologic morbidity in neonates with the hypoplastic left heart syndrome. Pediatrics [Internet]. 2001;107(6):1277-1282. http://pediatrics.aappublications.org/cgi/doi/10.1542/peds.107.6.1277
Quartermain MD, Pasquali SK, Hill KD, et al. Variation in prenatal diagnosis of congenital heart disease in infants. Pediatrics. 2015;136(2):e378-85.
Bakker MK, Bergman JEH, Krikov S, et al. Prenatal diagnosis and prevalence of critical congenital heart defects: an international retrospective cohort study. BMJ Open. 2019;9(7):1-12.
Holland B. Prenatal diagnosis of congenital heart defects in Kentucky: insight and opportunities. J Ky Med Assoc. 2013;111(5):126-131.
Bolin EH, Collins RT, Best TH, et al. Implementation of a statewide, multisite fetal tele-echocardiography program: evaluation of more than 1100 fetuses over 9 years. J Perinatol [Internet]. 2020;40(10):1524-1530. https://doi.org/10.1038/s41372-020-0677-2
Triedman JK, Newburger JW. Trends in congenital heart disease. Circulation. 2016;133(25):2716-2733.
Centers for Disease Control and Prevention. Racial Differences by Gestational Age in Neonatal Deaths Attributable to Congenital Heart Defects --- United States, 2003--2006 [Internet]; 2010. [cited 2018 Dec 18] https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5937a3.htm?s_cid=mm5937a3_e
Bonnet D, Coltri A, Butera G, et al. Reduces neonatal morbidity and mortality. Popul [Internet]. 1999;99(7):916-918. http://www.ncbi.nlm.nih.gov/pubmed/10027815
Holland BJ, Myers JA, Woods CR. Prenatal diagnosis of critical congenital heart disease reduces risk of death from cardiovascular compromise prior to planned neonatal cardiac surgery: a meta-analysis. Ultrasound Obstet Gynecol. 2015;45(6):631-638.
Trines J, Fruitman D, Zuo KJ, Smallhorn JF, Hornberger LK, Mackie AS. Effectiveness of prenatal screening for congenital heart disease: assessment in a jurisdiction with universal access to health care. Can J Cardiol [Internet]. 2013;29(7):879-885. https://doi.org/10.1016/j.cjca.2013.04.028
Campbell MJ, Lorch S, Rychik J, Quartermain MD, Passarella M, Groeneveld PW. Socioeconomic barriers to prenatal diagnosis of critical congenital heart disease. Prenat Diagn. 2020(3):341-346. https://doi.org/10.1002/pd.5864
Peiris V, Singh TP, Tworetzky W, Chong EC, Gauvreau K, Brown DW. Association of Socioeconomic Position and Medical Insurance with Fetal Diagnosis of Critical Congenital Heart Disease. Vol 2. Circulation: Cardiovascular Quality and Outcomes; 2009:354-360.
Stümpflen I, Stümpflen A, Wimmer M, Bernaschek G. Effect of detailed fetal echocardiography as part of routine prenatal ultrasonographic screening on detection of congenital heart disease. Lancet. 1996;348(9031):854-857.
Pike JI, Krishnan A, Donofrio MT. Early fetal echocardiography: congenital heart disease detection and diagnostic accuracy in the hands of an experienced fetal cardiology program. Prenat Diagn. 2014;34(8):790-796.
Sharma S, Parness IA, Kamenir SA, et al. Screening fetal echocardiography by telemedicine: efficacy and community acceptance. J Am Soc Echocardiogr. 2003;16(3):202-208.
Grant B, Morgan GJ, McCrossan BA, et al. Remote diagnosis of congenital heart disease: the impact of telemedicine. Arch Dis Child. 2010;95(4):276-280.
McCrossan BA, Sands AJ, Kileen T, Cardwell CR, Casey FA. Fetal diagnosis of congenital heart disease by telemedicine. Arch Dis Child Fetal Neonatal Ed. 2011;96(6):394-397.
Brown J, Holland B. Successful fetal tele-echo at a small regional hospital. Telemed e-Health. 2017;23(6):485-492. [Internet] http://online.liebertpub.com/doi/10.1089/tmj.2016.0141
U.S. Census Bureau QuickFacts: Kentucky [Internet]. [cited 2021 Jan 23] https://www.census.gov/quickfacts/KY
Donofrio MT, Moon-Grady AJ, Hornberger LK, et al. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the american heart association. Circulation. 2014;129(21):2183-2242.
Abuhamad A, Chaoui R. A Practical Guide to Fetal Echocardiography. 2nd ed. Lippincott Williams & Wilkins; 2010.
Hill GD, Block JR, Tanem JB, Frommelt MA. Disparities in the prenatal detection of critical congenital heart disease. Prenat Diagn. 2015;35(9):859-863.
2019 Poverty Rate in the United States [Internet]. [cited 2021 Jan 23] https://www.census.gov/library/visualizations/interactive/2019-poverty-rate.html