Practice variations for fetal and neonatal congenital heart disease within the Children's Hospitals Neonatal Consortium.
Journal
Pediatric research
ISSN: 1530-0447
Titre abrégé: Pediatr Res
Pays: United States
ID NLM: 0100714
Informations de publication
Date de publication:
05 2023
05 2023
Historique:
received:
04
05
2022
accepted:
03
09
2022
revised:
09
08
2022
medline:
12
5
2023
pubmed:
28
9
2022
entrez:
27
9
2022
Statut:
ppublish
Résumé
Many aspects of care for fetuses and neonates with congenital heart disease (CHD) fall outside standard practice guidelines, leading to the potential for significant variation in clinical care for this vulnerable population. We conducted a cross-sectional survey of site sponsors of the Children's Hospitals Neonatal Consortium, a multicenter collaborative of 41 Level IV neonatal intensive care units to assess key areas of clinical practice variability for patients with fetal and neonatal CHD. We received responses from 31 centers. Fetal consult services are shared by neonatology and pediatric cardiology at 70% of centers. Three centers (10%) routinely perform fetal magnetic resonance imaging (MRI) for women with pregnancies complicated by fetal CHD. Genetic testing for CHD patients is routine at 76% of centers. Preoperative brain MRI is standard practice at 5 centers (17%), while cerebral NIRS monitoring is regularly used at 14 centers (48%). Use of electroencephalogram (EEG) after major cardiac surgery is routine in 5 centers (17%). Neurodevelopmental follow-up programs are offered at 30 centers (97%). Many aspects of fetal and neonatal CHD care are highly variable with evolving shared multidisciplinary models. Many aspects of fetal and neonatal CHD care are highly variable. Genetic testing, placental examination, preoperative neuroimaging, and postoperative EEG monitoring carry a high yield of finding abnormalities in patients with CHD and these tests may contribute to more precise prognostication and improve care. Evidence-based standards for prenatal and postnatal CHD care may decrease inter-center variability.
Sections du résumé
BACKGROUND
Many aspects of care for fetuses and neonates with congenital heart disease (CHD) fall outside standard practice guidelines, leading to the potential for significant variation in clinical care for this vulnerable population.
METHODS
We conducted a cross-sectional survey of site sponsors of the Children's Hospitals Neonatal Consortium, a multicenter collaborative of 41 Level IV neonatal intensive care units to assess key areas of clinical practice variability for patients with fetal and neonatal CHD.
RESULTS
We received responses from 31 centers. Fetal consult services are shared by neonatology and pediatric cardiology at 70% of centers. Three centers (10%) routinely perform fetal magnetic resonance imaging (MRI) for women with pregnancies complicated by fetal CHD. Genetic testing for CHD patients is routine at 76% of centers. Preoperative brain MRI is standard practice at 5 centers (17%), while cerebral NIRS monitoring is regularly used at 14 centers (48%). Use of electroencephalogram (EEG) after major cardiac surgery is routine in 5 centers (17%). Neurodevelopmental follow-up programs are offered at 30 centers (97%).
CONCLUSIONS
Many aspects of fetal and neonatal CHD care are highly variable with evolving shared multidisciplinary models.
IMPACT
Many aspects of fetal and neonatal CHD care are highly variable. Genetic testing, placental examination, preoperative neuroimaging, and postoperative EEG monitoring carry a high yield of finding abnormalities in patients with CHD and these tests may contribute to more precise prognostication and improve care. Evidence-based standards for prenatal and postnatal CHD care may decrease inter-center variability.
Identifiants
pubmed: 36167818
doi: 10.1038/s41390-022-02314-2
pii: 10.1038/s41390-022-02314-2
doi:
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1728-1735Investigateurs
Kevin Sullivan
(K)
Victor McKay
(V)
Jamie Limjoco
(J)
Karna Murthy
(K)
Gustave Falciglia
(G)
Robert Lyle
(R)
Becky Rogers
(B)
Cherie Welch
(C)
Anthony Piazza
(A)
Priscilla Joe
(P)
Anne Hansen
(A)
Theresa Grover
(T)
Carl Coghill
(C)
Toby Yanowitz
(T)
Rashmin Savani
(R)
Eugenia Pallotto
(E)
Billie Short
(B)
An Massaro
(A)
Gregory Sysyn
(G)
Rachel Chapman
(R)
Girija Natarajan
(G)
Lynne Willett
(L)
Nicole Birge
(N)
Michael Uhing
(M)
Ankur Datta
(A)
Michel Mikhael
(M)
Beth Haberman
(B)
Annmarie Golioto
(A)
Annie Chi
(A)
Yvette Johnson
(Y)
Rajan Wadhawan
(R)
Kyong-Soon Lee
(KS)
Ajay Talati
(A)
Kristina Reber
(K)
Con Yee Ling
(CY)
Mark Speziale
(M)
Laurel Moyer
(L)
William Engle
(W)
Elizabeth Jacobsen-Misbe
(E)
Robert DiGeronimo
(R)
Suzanne Touch
(S)
Rakesh Rao
(R)
Beverly Brozanski
(B)
Gautham Suresh
(G)
Michael Padula
(M)
David Munson
(D)
Informations de copyright
© 2022. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.
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