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Serial fetal echocardiograms in hypoplastic left heart syndrome fetuses: Does it affect immediate post-natal care?
Bernadette Richards1, Lesley Freel1, Corey Stiver1
1Heart Center, Nationwide Children's Hospital, Columbus, OH, United States of America.
Insights
Serial fetal echocardiograms for fetuses with hypoplastic left heart syndrome (fHLHS) may not be necessary if the initial scan is clear. This study found no emergent post-natal cardiac interventions were needed in fHLHS cases with normal initial fetal echocardiograms.
Area of Science:
- Cardiology
- Fetal Medicine
- Neonatal Care
Background:
- Serial fetal echocardiograms are recommended for diagnosed congenital heart disease.
- The necessity and frequency of these scans are guided by clinical judgment.
- Fetuses with hypoplastic left heart syndrome (fHLHS) often undergo multiple prenatal ultrasounds.
Purpose of the Study:
- To evaluate if emergent post-natal cardiac interventions are required in fHLHS cases with no initial concerns on fetal echocardiogram.
- To determine the necessity of frequent serial fetal echocardiograms for predicting emergent post-natal needs.
Main Methods:
- Retrospective review of fetal echocardiograms for fHLHS between 2006 and 2018.
- Exclusion of cases with any initial concerns on fetal echocardiogram.
- Recording of unexpected emergent catheterization, surgical procedures, intubation, or inotropic support within 72 hours of birth.
Main Results:
- Eighty fHLHS cases were reviewed; 32 were excluded due to initial concerns.
- No patient required emergent catheterization or surgery within 72 hours if the initial fetal echocardiogram was normal.
- Seven patients needed intubation and one received inotropic support, not directly linked to missed fetal diagnoses.
Conclusions:
- Normal initial fetal echocardiograms in fHLHS cases correlate with no need for emergent post-natal cardiac procedures.
- Post-natal interventions that occurred could not be attributed to missed fetal cardiac diagnoses.
- Frequent serial fetal echocardiograms may not be essential for predicting emergent post-natal intervention needs in fHLHS.
Abstract:
Guidelines recommend serial fetal echocardiograms when congenital heart disease is diagnosed. Necessity, timing, and frequency of serial echocardiograms are based on clinical judgment. Fetuses with hypoplastic left heart syndrome (fHLHS) may undergo multiple studies prior to birth. Goal of this study was to determine if the need for unexpected, emergent cardiac interventions were required immediately post-natally, if there were no concerns on initial fetal echocardiogram.
Methods:
Fetal echocardiograms performed between 2006 and 2018 on fHLHS were reviewed. fHLHS were excluded if initial fetal scan documented any other concerns. Unexpected, emergent catheterization or surgical procedures, intubation, or inotropic support within the first 72 h of life were recorded.
Results:
Total of 80 fHLHS were reviewed. Thirty-two fHLHS were excluded because of concerns on the initial fetal echocardiogram. Sixteen fHLHS had one scan, 14 had two scans, 13 had three scans, and 5 had four scans. No patient underwent an unexpected, emergent catheterization or surgical procedure within the first 72 h of life. Seven patients required intubation and 1 patient received inotropic support within the first 72 h of life.
Conclusion:
No fHLHS underwent an unexpected, emergent catheterization or surgical procedure within the first 72 h of life if the initial fetal echocardiogram had no significant concerns. Medical interventions did occur immediately post-natally, but could not be directly attributed to a missed fetal cardiac diagnosis. Frequent serial fetal echocardiograms may not necessarily be needed to predict the need for an unexpected, emergent procedure.
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