Prenatal diagnosis of hypoplastic left heart syndrome was associated with fewer adverse perioperative neurologic events (OR 0.46) compared to postnatal diagnosis, but did not reduce hospital mortality.
Cohort (n=216)
No
Does prenatal diagnosis reduce neurologic morbidity and operative mortality in neonates with hypoplastic left heart syndrome?
Prenatal diagnosis of HLHS reduces early neurologic morbidity, likely due to earlier initiation of prostaglandin E1, though it does not significantly improve hospital mortality.
Effect estimate: OR 0.46
BACKGROUND: Prenatal echocardiography can identify the fetus that has complex congenital heart disease and may improve early management and surgical outcome. Prenatal diagnosis may be particularly beneficial to patients who have hypoplastic left heart syndrome (HLHS) and who are at risk for hypoxic-ischemic insult at presentation. OBJECTIVES: We sought to determine whether prenatal diagnosis reduces neurologic morbidity and operative mortality in patients who undergo palliative surgery for the HLHS. METHODS: Data from all patients who had HLHS, except for those with lethal genetic anomalies, and who were admitted to our institution between July 1992 and September 1997 were analyzed to assess the impact of prenatal diagnosis on preoperative management, neurologic morbidity, and surgical mortality. The primary outcome measures were hospital mortality and the incidence of adverse neurologic events (seizure or coma). RESULTS: There were 216 patients who had HLHS and were referred for surgical palliation, 79 (36.6%) of whom had been diagnosed prenatally. All patients who had been diagnosed prenatally were delivered in an advanced nursery and were started on prostaglandin E(1) on the first day of life. Patients whose HLHS was diagnosed postnatally were begun on prostaglandin E(1) later in life (median = day 2 range = 1-28 days). There were 4 preoperative deaths and 53 operative or postoperative deaths. Overall hospital mortality was 26.4% and did not differ between patients whose HLHS had been diagnosed prenatally and those whose HLHS had been diagnosed postnatally. With the use of multivariable analysis, prenatal diagnosis was associated with fewer adverse perioperative neurologic events in the patients whose HLHS had been diagnosed prenatally than in those whose HLHS had been diagnosed postnatally (odds ratio = 0.46). CONCLUSIONS: These data suggest that prenatal diagnosis has a favorable impact on treatment of patients who have HLHS and are undergoing staged palliation and reduces early neurologic morbidity. Prenatal diagnosis was not associated with reduced hospital mortality. It is possible that prenatal diagnosis may improve long-term neurologic outcome.
Mahle et al. (Fri,) conducted a cohort in Hypoplastic left heart syndrome (HLHS) (n=216). Prenatal diagnosis vs. Postnatal diagnosis was evaluated on Hospital mortality and the incidence of adverse neurologic events (seizure or coma) (OR 0.46). Prenatal diagnosis of hypoplastic left heart syndrome was associated with fewer adverse perioperative neurologic events (OR 0.46) compared to postnatal diagnosis, but did not reduce hospital mortality.