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Impact on Transport Resource Utilisation in Newborn Congenital Heart Disease Diagnosed Postnatally
Sally E Jeston1, Leah M Hickey2, Diana Zannino3
1Department of Paediatrics, The University of Melbourne, Melbourne, Vic, Australia; Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Vic, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Vic, Australia.
Insights
Newborns with critical congenital heart disease (CHD) diagnosed after birth require more intensive retrieval care than those diagnosed before birth. Earlier suspicion by clinicians can improve outcomes for at-risk infants.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Critical Care Medicine
Background:
- Critical congenital heart disease (CHD) is a significant cause of neonatal mortality.
- Timely diagnosis and intervention are crucial for improving outcomes in neonates with critical CHD.
- Existing literature lacks detailed comparisons of retrieval interventions based on antenatal versus postnatal diagnosis of critical CHD.
Purpose of the Study:
- To describe and compare neonatal retrieval medical interventions for newborns with critical CHD.
- To analyze differences in retrieval resource intensity between postnatal and antenatal diagnosis groups.
- To identify factors influencing the timing of presentation and retrieval for infants with critical CHD.
Main Methods:
- Retrospective medical record review of infants (≤30 days) with CHD admitted to a tertiary pediatric hospital (2016-2020).
- Data collection included demographics, presenting signs, retrieval events, and mortality.
- Infants were categorized into postnatal diagnosis and antenatal diagnosis groups for comparative analysis.
Main Results:
- 30% of 335 infants with CHD had a postnatal diagnosis.
- Postnatal diagnosis group experienced more resource-intensive retrievals, requiring greater respiratory support, oxygen, nitric oxide, and antibiotics.
- Infants with postnatal diagnosis presented with more severe respiratory and cardiovascular signs, with median symptom presentation at 26 hours and emergency retrieval at 91 hours.
Conclusions:
- Postnatal diagnosis of critical CHD leads to later presentation, increased illness severity, and more resource-intensive emergency retrievals.
- A lower threshold for suspecting CHD in newborns by referring clinicians may facilitate earlier transport of at-risk infants.
- Further research is needed to expedite cardiac diagnosis at the point of illness presentation.
Aim:
This study aimed to describe and compare neonatal retrieval medical interventions among newborns with a postnatal vs antenatal diagnosis of critical congenital heart disease (CHD).
Method:
The study design was a retrospective medical record review of infants aged ≤30 days admitted to The Royal Children's Hospital, Melbourne, Australia, with CHD from 2016 to 2020. Electronic data were collected, including demographic data, presenting signs, retrieval events, and mortality. Participants were separated into two groups for analysis: those with a postnatal diagnosis and those with an antenatal diagnosis of CHD.
Results:
Of the 335 infants admitted with CHD, 30% had a postnatal diagnosis. Infants with a postnatal diagnosis had more resource-intensive retrievals requiring more respiratory support, supplemental oxygen, inhaled nitric oxide, and antibiotic administration. These infants also presented with higher numbers of respiratory and cardiovascular signs of illness at presentation. For infants with a postnatal diagnosis of critical CHD, the median age at symptom presentation and emergency retrieval was 26 and 91 hours, respectively. Four percent of infants died before 30 days of age.
Conclusions:
Infants with a postnatal diagnosis of critical CHD present later, with more signs of illness, resulting in more resource-intensive emergency retrievals. A lower threshold for suspicion of CHD by referring paediatric clinicians in the newborn period may enable more timely transport of at-risk infants. This study has identified potential areas for future research aimed at expediting cardiac diagnosis at the time of illness presentation.
