Key result
Fetal echocardiography predicted the need for urgent intervention, ECMO, or death within 2 hours of birth with a 50% positive predictive value for high-risk fetal cardiac disease.
Why the study?
Distances between delivery centers and cardiac services challenge care for fetuses with cardiac disease at risk of acute cardiorespiratory instability at birth.
Does a fetal echocardiography-based algorithm accurately predict the need for immediate postnatal intervention and safely guide planned delivery in a pediatric cardiac operating room for high-risk fetal cardiac disease?
Cohort (n=670)
No
Does a fetal echocardiography-based algorithm accurately predict the need for immediate postnatal intervention and safely guide planned delivery in a pediatric cardiac operating room for high-risk fetal cardiac disease?
Effect estimate: PPV 50%
A fetal echocardiography-based algorithm effectively predicts the need for urgent postnatal intervention in high-risk congenital heart disease, facilitating planned delivery in a pediatric cardiac operating room to minimize transport risks.
May aid risk stratification for high-risk fetal cardiac disease; leaves open prospective validation of delivery planning safety.
Background Distances between delivery centers and cardiac services can make the care of fetuses with cardiac disease(CD) at risk of acute cardiorespiratory instability(ACRI) at birth a challenge. In 2013 we implemented a fetal echocardiography(FE)-based algorithm targeting fetuses considered high-risk for ACRI at ≤2 hours of birth for Caesarian section(CS) delivery in our pediatric cardiac operating room(PCOR) of our children’s hospital. We examine the experience and outcomes of affected newborns. Methods We reviewed maternal and postnatal medical records of all fetuses with CD at high-risk for ACRI encountered January 2013-March 2022. Secondary analysis was performed including all fetuses with diagnoses of d-transposition of the great arteries/intact ventricular septum(d-TGA/IVS) and hypoplastic left heart syndrome(HLHS) encountered over the study period. Results Forty fetuses were considered high-risk for ACRI: 15 d-TGA/IVS and 7 HLHS with restrictive atrial septum(RAS), 4 absent pulmonary valve syndrome, 3 obstructed anomalous pulmonary veins, 2 severe Ebstein anomaly, 2 thoracic/intracardiac tumors and 7 others. PCOR delivery occurred for 33 but not for 7 (5 d-TGA/IVS, 2 HLHS with RAS). For high-risk cases, FE had a positive predictive value of 50% for intervention/ECMO/death at ≤2 hours and 70% at ≤24 hours. Of “low-risk” cases, 6/46 with d-TGA/IVS and 0/45 with HLHS required intervention at ≤2 hours. FE predicted intervention/ECMO/death at ≤2hours with a sensitivity of 67%, specificity 93%, and positive and negative predictive values of 87% and 87%, respectively, for d-TGA/IVS, and 100%, 95%, 71%, and 100% for HLHS, respectively. Conclusions FE predicts need for urgent intervention in majority with d-TGA/IVS and HLHS, and in half of the entire spectrum of high-risk CD.
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Moray et al. (2023) conducted a cohort in Fetal cardiac disease (n=670). Fetal echocardiography-based risk stratification vs. Low-risk classification was evaluated on Need for intervention, ECMO, or death at <2 hours after birth (PPV 50%). Fetal echocardiography predicted the need for urgent intervention, ECMO, or death within 2 hours of birth with a 50% positive predictive value for high-risk fetal cardiac disease.
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