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Practice variations for fetal and neonatal congenital heart disease within the Children's Hospitals Neonatal

Rachel L Leon1, Philip T Levy2, June Hu3

  • 1Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA. Rachel.Leon@UTSouthwestern.edu.

Pediatric Research
|September 27, 2022
PubMed

Insights

Care for fetal and neonatal congenital heart disease (CHD) varies significantly. This study highlights inconsistencies in diagnostic testing and neuroprotection strategies, emphasizing the need for standardized evidence-based practices to improve outcomes for these vulnerable infants.

Area of Science:

  • Neonatology
  • Pediatric Cardiology
  • Fetal Medicine

Background:

  • Care for fetuses and neonates with congenital heart disease (CHD) often lacks standard practice guidelines.
  • This variability can lead to significant differences in clinical care for this vulnerable population.

Purpose of the Study:

  • To assess clinical practice variability in fetal and neonatal CHD care across multiple centers.
  • To identify key areas where standardized approaches may be beneficial.

Main Methods:

  • A cross-sectional survey was distributed to site sponsors within the Children's Hospitals Neonatal Consortium.
  • The survey targeted 41 Level IV neonatal intensive care units (NICUs) to gather data on clinical practices for CHD patients.

Main Results:

  • Responses were received from 31 centers, revealing significant variability in practices.
  • Fetal MRI is used routinely at only 10% of centers, while genetic testing is routine at 76%.
  • Preoperative brain MRI (17%) and postoperative EEG monitoring (17%) are not consistently implemented, though neurodevelopmental follow-up is common (97%).

Conclusions:

  • Significant variability exists in the management of fetal and neonatal congenital heart disease.
  • Multidisciplinary models are evolving, but evidence-based standards are needed to reduce inter-center variability and improve patient care.
  • Implementing standardized genetic testing, neuroimaging, and monitoring may enhance prognostication and care precision.
Abstract

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