Predicting High‐Risk Fetal Cardiac Disease Anticipated to Need Immediate Postnatal Stabilization and Intervention with Planned Pediatric Cardiac Operating Room Delivery
Background Distances between delivery and cardiac services can make the care of fetuses with cardiac disease at risk of acute cardiorespiratory instability at birth a challenge. In 2013 we implemented a fetal echocardiography‐based algorithm targeting fetuses considered high risk for acute cardiores...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-03-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.031184 |
| _version_ | 1797257380183932928 |
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| author | Amol Moray Proscovia M. Mugaba Chloe Joynt Angela McBrien Luke G. Eckersley Ernest Phillipos Paula Holinski Lindsay Ryerson James Yashu Coe Sujata Chandra Billy Wong Michele Derbyshire Maria Lefebvre Mohammed Al Aklabi Lisa K. Hornberger |
| author_facet | Amol Moray Proscovia M. Mugaba Chloe Joynt Angela McBrien Luke G. Eckersley Ernest Phillipos Paula Holinski Lindsay Ryerson James Yashu Coe Sujata Chandra Billy Wong Michele Derbyshire Maria Lefebvre Mohammed Al Aklabi Lisa K. Hornberger |
| author_sort | Amol Moray |
| collection | DOAJ |
| description | Background Distances between delivery and cardiac services can make the care of fetuses with cardiac disease at risk of acute cardiorespiratory instability at birth a challenge. In 2013 we implemented a fetal echocardiography‐based algorithm targeting fetuses considered high risk for acute cardiorespiratory instability at ≤2 hours of birth for delivery in our pediatric cardiac operating room of our children's hospital, and, herein, examine our experience. Methods and Results We reviewed maternal and postnatal medical records of all fetuses with cardiac disease encountered January 2013 to March 2022 considered high risk for acute cardiorespiratory instability. Secondary analysis was performed including all fetuses with diagnoses of d‐transposition of the great arteries/intact ventricular septum (d‐TGA/IVS) and hypoplastic left heart syndrome (HLHS) encountered over the study period. Forty fetuses were considered high risk for acute cardiorespiratory instability: 15 with d‐TGA/IVS and 7 with HLHS with restrictive atrial septum, 4 with absent pulmonary valve syndrome, 3 with obstructed anomalous pulmonary veins, 2 with severe Ebstein anomaly, 2 with thoracic/intracardiac tumors, and 7 others. Pediatric cardiac operating room delivery occurred for 33 but not for 7 (5 with d‐TGA/IVS, 2 with HLHS with restrictive atrial septum). For high‐risk cases, fetal echocardiography had a positive predictive value of 50% for intervention/extracorporeal membrane oxygenation/death at ≤2 hours and 70% at ≤24 hours. Of “low‐risk” cases, 6/46 with d‐TGA/IVS and 0/45 with HLHS required intervention at ≤2 hours. Fetal echocardiography for predicting intervention/extracorporeal membrane oxygenation/death at ≤2 hours had a sensitivity of 67%, specificity 93%, and positive and negative predictive values of 80% and 87%, respectively, for d‐TGA/IVS, and 100%, 95%, 71%, and 100% for HLHS, respectively. Conclusions Fetal echocardiography can predict the need for urgent intervention in a majority with d‐TGA/IVS and HLHS and in half of the entire spectrum of high‐risk cardiac disease. |
| first_indexed | 2024-04-24T22:36:43Z |
| format | Article |
| id | doaj.art-4f41d4d338784b8b9fa439bdcac0b71a |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-24T22:36:43Z |
| publishDate | 2024-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-4f41d4d338784b8b9fa439bdcac0b71a2024-03-19T10:07:06ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-03-0113610.1161/JAHA.123.031184Predicting High‐Risk Fetal Cardiac Disease Anticipated to Need Immediate Postnatal Stabilization and Intervention with Planned Pediatric Cardiac Operating Room DeliveryAmol Moray0Proscovia M. Mugaba1Chloe Joynt2Angela McBrien3Luke G. Eckersley4Ernest Phillipos5Paula Holinski6Lindsay Ryerson7James Yashu Coe8Sujata Chandra9Billy Wong10Michele Derbyshire11Maria Lefebvre12Mohammed Al Aklabi13Lisa K. Hornberger14Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics University of Alberta, Stollery Children’s Hospital Edmonton Alberta CanadaFetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics University of Alberta, Stollery Children’s Hospital Edmonton Alberta CanadaDivision of Neonatology, Department of Pediatrics University of Alberta, Stollery Children’s Hospital Edmonton Alberta CanadaFetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics University of Alberta, Stollery Children’s Hospital Edmonton Alberta CanadaFetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics University of Alberta, Stollery Children’s Hospital Edmonton Alberta CanadaDivision of Neonatology, Department of Pediatrics University of Alberta, Stollery Children’s Hospital Edmonton Alberta CanadaDivision of Critical Care, Department of Pediatrics University of Alberta, Stollery Children’s Hospital Edmonton Alberta CanadaDivision of Critical Care, Department of Pediatrics University of Alberta, Stollery Children’s Hospital Edmonton Alberta CanadaInterventional Cardiology, Division of Cardiology, Department of Pediatrics University of Alberta, Stollery Children’s Hospital Edmonton Alberta CanadaDepartment of Obstetrics & Gynecology University of Alberta Edmonton Alberta CanadaDepartment of Obstetrics & Gynecology University of Alberta Edmonton Alberta CanadaStollery Pediatric and Mazankowski Adult Cardiac Operating Rooms, Alberta Health Services Edmonton Alberta CanadaAlberta Health Services and Stollery Children’s Hospital Edmonton Alberta CanadaDivision of Pediatric Cardiovascular Surgery, Department of Surgery University of Alberta, Stollery Children’s Hospital Edmonton Alberta CanadaFetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics University of Alberta, Stollery Children’s Hospital Edmonton Alberta CanadaBackground Distances between delivery and cardiac services can make the care of fetuses with cardiac disease at risk of acute cardiorespiratory instability at birth a challenge. In 2013 we implemented a fetal echocardiography‐based algorithm targeting fetuses considered high risk for acute cardiorespiratory instability at ≤2 hours of birth for delivery in our pediatric cardiac operating room of our children's hospital, and, herein, examine our experience. Methods and Results We reviewed maternal and postnatal medical records of all fetuses with cardiac disease encountered January 2013 to March 2022 considered high risk for acute cardiorespiratory instability. Secondary analysis was performed including all fetuses with diagnoses of d‐transposition of the great arteries/intact ventricular septum (d‐TGA/IVS) and hypoplastic left heart syndrome (HLHS) encountered over the study period. Forty fetuses were considered high risk for acute cardiorespiratory instability: 15 with d‐TGA/IVS and 7 with HLHS with restrictive atrial septum, 4 with absent pulmonary valve syndrome, 3 with obstructed anomalous pulmonary veins, 2 with severe Ebstein anomaly, 2 with thoracic/intracardiac tumors, and 7 others. Pediatric cardiac operating room delivery occurred for 33 but not for 7 (5 with d‐TGA/IVS, 2 with HLHS with restrictive atrial septum). For high‐risk cases, fetal echocardiography had a positive predictive value of 50% for intervention/extracorporeal membrane oxygenation/death at ≤2 hours and 70% at ≤24 hours. Of “low‐risk” cases, 6/46 with d‐TGA/IVS and 0/45 with HLHS required intervention at ≤2 hours. Fetal echocardiography for predicting intervention/extracorporeal membrane oxygenation/death at ≤2 hours had a sensitivity of 67%, specificity 93%, and positive and negative predictive values of 80% and 87%, respectively, for d‐TGA/IVS, and 100%, 95%, 71%, and 100% for HLHS, respectively. Conclusions Fetal echocardiography can predict the need for urgent intervention in a majority with d‐TGA/IVS and HLHS and in half of the entire spectrum of high‐risk cardiac disease.https://www.ahajournals.org/doi/10.1161/JAHA.123.031184cardiorespiratory compromisecongenital heart diseasefetal echocardiographyfetal heart diseaseneonatology |
| spellingShingle | Amol Moray Proscovia M. Mugaba Chloe Joynt Angela McBrien Luke G. Eckersley Ernest Phillipos Paula Holinski Lindsay Ryerson James Yashu Coe Sujata Chandra Billy Wong Michele Derbyshire Maria Lefebvre Mohammed Al Aklabi Lisa K. Hornberger Predicting High‐Risk Fetal Cardiac Disease Anticipated to Need Immediate Postnatal Stabilization and Intervention with Planned Pediatric Cardiac Operating Room Delivery Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiorespiratory compromise congenital heart disease fetal echocardiography fetal heart disease neonatology |
| title | Predicting High‐Risk Fetal Cardiac Disease Anticipated to Need Immediate Postnatal Stabilization and Intervention with Planned Pediatric Cardiac Operating Room Delivery |
| title_full | Predicting High‐Risk Fetal Cardiac Disease Anticipated to Need Immediate Postnatal Stabilization and Intervention with Planned Pediatric Cardiac Operating Room Delivery |
| title_fullStr | Predicting High‐Risk Fetal Cardiac Disease Anticipated to Need Immediate Postnatal Stabilization and Intervention with Planned Pediatric Cardiac Operating Room Delivery |
| title_full_unstemmed | Predicting High‐Risk Fetal Cardiac Disease Anticipated to Need Immediate Postnatal Stabilization and Intervention with Planned Pediatric Cardiac Operating Room Delivery |
| title_short | Predicting High‐Risk Fetal Cardiac Disease Anticipated to Need Immediate Postnatal Stabilization and Intervention with Planned Pediatric Cardiac Operating Room Delivery |
| title_sort | predicting high risk fetal cardiac disease anticipated to need immediate postnatal stabilization and intervention with planned pediatric cardiac operating room delivery |
| topic | cardiorespiratory compromise congenital heart disease fetal echocardiography fetal heart disease neonatology |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.031184 |
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