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Prenatal detection of congenital heart disease--results of a national screening programme
C L van Velzen1, S A Clur2, M E B Rijlaarsdam3
1Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands.
Insights
A national screening program significantly improved prenatal detection rates for congenital heart disease (CHD), increasing from 35.8% to 59.7%. This led to a decrease in late diagnoses, improving outcomes for affected newborns.
Area of Science:
- Cardiology
- Prenatal Diagnostics
- Public Health
Background:
- Congenital heart disease (CHD) is a leading cause of infant mortality and morbidity.
- Early prenatal detection of CHD is crucial for improving neonatal outcomes and surgical planning.
- The Netherlands implemented a national prenatal screening program for CHD in 2007.
Purpose of the Study:
- To evaluate the impact of the national prenatal screening program on the detection rates of severe congenital heart disease.
- To assess changes in the timing of CHD diagnosis before and after the program's introduction.
Main Methods:
- A geographical cohort study was conducted.
- Data included fetuses and infants diagnosed with severe CHD between 2002 and 2012, encompassing periods before and after screening implementation.
- Detection rates and referral timing were analyzed.
Main Results:
- The overall prenatal detection rate for severe CHD increased from 35.8% to 59.7% after the screening program's introduction.
- Detection rates for isolated CHD rose from 22.8% to 44.2%.
- Late-term referrals (after 24 weeks gestation) decreased by 24.3%.
Conclusions:
- The national screening program has significantly enhanced the prenatal detection of severe CHD in an unselected population.
- The achieved detection rate of 59.7% is notably high compared to previous studies.
- The program has successfully reduced late diagnoses, likely improving neonatal care and outcomes.
Objective:
Congenital heart disease (CHD) is the most common congenital malformation and causes major morbidity and mortality. Prenatal detection improves the neonatal condition before surgery, resulting in less morbidity and mortality. In the Netherlands a national prenatal screening programme was introduced in 2007. This study evaluates the effects of this screening programme.
Design:
Geographical cohort study.
Setting:
Large referral region of three tertiary care centres.
Population:
Fetuses and infants diagnosed with severe CHD born between 1 January 2002 and 1 January 2012.
Methods:
Cases were divided into two groups: before and after the introduction of screening.
Main Outcome Measures:
Detection rates were calculated.
Results:
The prenatal detection rate (n = 1912) increased with 23.9% (95% confidence interval [95% CI] 19.5-28.3) from 35.8 to 59.7% after the introduction of screening and of isolated CHD with 21.4% (95% CI 16.0-26.8) from 22.8 to 44.2%. The highest detection rates were found in the hypoplastic left heart syndrome, other univentricular defects and complex defects with atrial isomerism (>93%). Since the introduction of screening, the 'late' referrals (after 24 weeks of gestation) decreased by 24.3% (95% CI 19.3-29.3).
Conclusions:
This is the largest cohort study to investigate the prenatal detection rate of severe CHD in an unselected population. A nationally organised screening has resulted in a remarkably high detection rate of CHD (59.7%) compared with earlier literature.
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