Comparison of babies with critical congenital heart disease who were prenatally diagnosed with fetal echocardiography and postnatally diagnosed in the pediatric cardiology clinic and followed in the neonatal intensive care unit, in terms of morbidity and mortality

Objective: The impact of prenatal diagnosis on the survival outcome of infants with critical congenital heart disease (CCHD) is still unknown. The aim of this study is to make a comparison in terms of morbidity and mortality between babies with CCHD diagnosed prenatally and postnatally and given Prostaglandin E1 infusion. Materials and Methods: Patients who were hospitalized and monitored in the Neonatal Intensive Care Unit between August 1, 2019 and July 31, 2022 and whose single-center file information was available on the data obtained from babies diagnosed with CHD were included. Data from a total of 122 (41 prenatal and 81 postnatal) babies diagnosed with CHD were analyzed. Diagnosis time, birth week, birth weight, NICU admission day, hospitalization duration, CHD diagnosis, PGE1 infusion duration and maximum dose, PGE1 side effect, interventional or surgical treatment applied, and exitus/discharge status were obtained from the file records. Results: 33.6% of the patients were diagnosed prenatally and 66.4% were diagnosed postnatally. The average diagnosis time of patients diagnosed postnatally is 2.2±1.9 days. 53.7% of those with prenatal diagnosis and 58% of those with postnatal diagnosis were male, and no significant difference was found between the groups in terms of gender. For those with prenatal diagnosis, the median week of birth was 38 (29.6-39.7) weeks, and the mean value of birth weight was 2.86±0.60 kg; For those diagnosed with postnatal diagnosis, the median week of birth is 38 (29.9-42.0) weeks and the average value of birth weight is 3.0±0.64 kg. No significant difference was found between the groups in terms of gestational age and birth weight parameters. 63.9% of the patients were referred from an external center. 9.8% of those with prenatal diagnosis and 91.4% of those with postnatal diagnosis were referred from an external center, and this difference between the groups is statistically significant. When total cases were examined without dividing them into groups, it was determined that the three most common CCHD diagnoses were great artery transposition (25.4%), aortic hypolasia (21.3%) and hypoplastic left heart syndrome (18.0%). The most common diagnoses in patients with prenatal diagnosis are hypoplastic left heart syndrome (26.8%), aortic hypoplasia (24.4%) and great artery transposition (17.1%). The most common diagnoses in patients with postnatal diagnosis were great artery transposition (29.6%), aortic hypolasia (19.8%) and hypoplastic left heart syndrome (13.6%), respectively. Considering the patients' characteristics regarding hospitalization, the NICU stay of patients with postnatal diagnosis was found to be significantly longer than that of patients with prenatal diagnosis. The postnatal age of those with postnatal diagnosis was found to be significantly longer than those with prenatal diagnosis. In those who exited, the NICU stay was shorter, the prostaglandin infusion time was longer, and the maximum prostaglandin dose values were significantly higher. 41.1% of those who underwent invasive procedures and 71.2% of those who did not undergo exitus. Of the patients with and without exitus due to critical congenital heart disease, 55.7% of those with comorbidities had exitus and 25% of those without comorbidities. According to the regression model, a 1-day increase in prostaglandin infusion duration increases the risk of exitus by 1.25 times. An increase of 0.01 mcg/kg/min in the maximum dose of prostaglandin increases the risk of exitus by 1.28 times. A 1-day decrease in hospitalization time increases the risk of exitus by 1.06 times. Conclusion: There was no significant difference between the groups with critical congenital heart disease diagnosed prenatally and postnatally in terms of gender, gestational age, birth weight, and mortality. The duration of hospital stay is significantly longer in patients with postnatal diagnosis. It has been observed that mortality increases significantly in patients with CHD if no interventional procedure/surgical treatment is performed. Finally, it was found that the risk of exitus increased as the prostaglandin infusion duration and the maximum prostaglandin dose increased. According to the characteristics of the patients regarding hospitalization, the length of stay in the NICU of patients with postnatal diagnosis was significantly longer than that of patients with prenatal diagnosis, which shows us the importance of fetal echocardiography. Fetal echocardiography is an effective prenatal screening method and has been found to be important in prenatal diagnosis. Therefore, it has been revealed that rapid screening and interventional procedures are also important. As a result of our study, we think that good definition and evaluation of prenatal and postnatal diagnosis and reducing postnatal complications and preoperative mortality can increase survival rates in newborns with CCHD. Keywords: Critical Congenital Heart Diseases, Prenatal Diagnosis, Fetal Echocardiography, Prenatal Diagnosis, Morbidity, Mortality