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Transport of infants with congenital heart disease: benefits of antenatal diagnosis

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Abstract

Infants with significant congenital heart disease (CHD) typically require transport from their birth centre to a regional paediatric cardiac centre. Antenatal diagnosis of CHD allows early pre-emptive stabilisation, and is associated with improved early clinical status. However, the effect of antenatal diagnosis on the transport characteristics of infants with CHD has not been previously investigated. The aim of this study was to compare the transport characteristics of infants with antenatal and postnatal diagnosis of CHD. This study is a retrospective cohort study of all infants of ≤10 days and ≥34 weeks of gestation with CHD admitted to the Royal Children's Hospital, Melbourne (RCH) over 5 years. Demographic, diagnosis, and transport data were recorded. Cases of complex CHD were included in this study. Of 320 infants with complex CHD, 198 (62 %) had antenatal diagnosis (ANdx) and 122 (38 %) had postnatal diagnosis (PNdx). There was no significant difference in sex, birth weight, or gestation between ANdx and PNdx groups. Average age of referral was 15 vs. 53.4 h in ANdx vs. PNdx groups. Aggregate transfer distance in the ANdx group was 2216 km and in the PNdx group was 10,274 km (P < 0.0001). Of the infants, 39 % in the PNdx group required highest-acuity “time critical” transports compared to 6 % of ANdx infants (P = 0.0001). Conversely, only 11 % of the infants in the PNdx group had lowest acuity “non-urgent” transfers, compared to 24 % of ANdx infants (P = 0.003). PNdx was associated with significantly higher rates of invasive ventilation (36 vs 20 %; P = 0.01) and higher rates of inotrope use (19 vs. 9 %; P = 0.007) during transport. Conclusions: Improved antenatal detection would allow for safer, less resource intense transfers of infants with CHD.

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Abbreviations

ANDx:

Antenatally diagnosed

CHD:

Congenital heart disease

CoA:

Coarctation of aorta

CPAP:

Continuous positive airway pressure

HLHS:

Hypoplastic left heart syndrome

IMV:

Invasive mandatory ventilation

iNO:

Inhaled nitric oxide

IUGR:

Intrauterine growth retardation

NETS:

Newborn Emergency Transport Service, Victoria

PGE1 :

Prostaglandin E1

PNDx:

Postnatally diagnosed

PA:

Pulmonary atresia

RCH:

Royal Children Hospital, Melbourne

TGA:

Transposition of the great arteries

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Authors and Affiliations

  1. Newborn Emergency Transport Services, Royal Children’s Hospital, Melbourne, Australia

    Neelam Gupta & Michael Stewart

  2. Royal Children’s Hospital, Melbourne, Australia

    Louise Leven, Michael Cheung & Neil Patel

  3. Neonatal Unit, Level 2, Women’s Centre, John Radcliffe Hospital, Oxford, OX39DU, UK

    Neelam Gupta

Authors
  1. Neelam Gupta
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  2. Louise Leven
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  3. Michael Stewart
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  4. Michael Cheung
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  5. Neil Patel
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Correspondence to Neelam Gupta.

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Gupta, N., Leven, L., Stewart, M. et al. Transport of infants with congenital heart disease: benefits of antenatal diagnosis. Eur J Pediatr 173, 655–660 (2014). https://doi.org/10.1007/s00431-013-2231-0

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  • DOI: https://doi.org/10.1007/s00431-013-2231-0

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