6523 Postnatal follow up after foetal echocardiograms – what is the best practise?

Objectives To review effectiveness of postnatal follow up pathway of babies who had foetal echocardiograms. Methods Retrospective data collection for a period of one year from Jan 2022 to Dec 2022. We reviewed the foetal echocardiogram reports, maternal and babies' medical records including correspondence from tertiary centre. Results Total of 63 babies were referred for foetal echocardiograms. Indications for referral were family history of cardiac disease in first degree relatives (39), abnormal anomaly scans(16), maternal risk factors such as Anti-Ro antibodies, genetic condition and medications (3), increased nuchal translucency (5) Of the 39 babies referred for family history, five patients did not have foetal echocardiograms (three declined and two refused due to late gestation at referral). 29 of 34 foetal echocardiograms (85%) were normal (including two with atrial ectopics, which resolved in later gestation). Only five babies had abnormal foetal echocardiograms – Two had mild pericardial effusion which resolved later, one had hypoplastic aortic arch, one had small ventricular septal defect with aberrant right subclavian artery, one baby had prominent aorta. 8 other babies had abnormal foetal echocardiograms, done following abnormal anomaly scans (75% of abnormal anomaly scans). Graph 1 shows all 17 abnormalities. Only two babies with abnormal foetal echocardiogram were delivered at a tertiary centre and rest were delivered in the DGH. Majority of the babies with abnormal foetal echocardiograms had postnatal echocardiograms with the PEC (Paediatrician with Expertise in Cardiology) locally (71%).Outcomes of 17 babies with abnormal foetal echocardiograms (graph 2). one baby with TGA and one with Tetralogy of Fallot with absent pulmonary valve were delivered at tertiary centre Four babies had echocardiograms locally by the PEC and then subsequently seen at tertiary centre with the following diagnoses- mild hypoplasia of aortic arch with abnormal mitral valve leaflets, right aortic arch with aberrant left subclavian artery, VSD, one baby with VSD, PDA and ASD. Five followed up by PEC for hemodynamically insignificant cardiac lesions Three discharged after normal echocardiogram One baby with pericardial effusion did not have postnatal review as the effusion resolved at later gestation One baby was referred to tertiary centre due to family history of cardiomyopathy One lost to follow up Conclusion This study supports that majority of babies with abnormal foetal echocardiograms can be delivered safely in a DGH. The antenatally diagnosed cardiac defects which do not require immediate cardiac intervention can be managed initially by a PEC with input from a tertiary cardiologist. Reference Antenatal diagnosis of critical congenital heart disease- Optimal place of delivery is where appropriate care can be delivered Julene S Carvalho. PMID: 26819268 DOI: 10.1136/archdischild-2015-308736.