Early period prognosis in newborns with congenital heart disease retrospective evaluation

ABSTRACT Introduction Congenital heart diseases include inherited structural and functional abnormalities in the cardiovascular system. The incidence of congenital heart diseases in live births varies between 0,8-0,9 %. Among congenital anomalies, CHD have the highest risk for mortality. With advanced imaging methods the rate of antenatal diagnosis has increased although it is not possible to recognize all congenital heart diseases before birth. Mortality related with CHD occurs most commonly in the neonatal period. Newborns with CHD are admitted to NICU's in Turkey. Data on the incidence and the mortality rate of CHD is very limited for our country. In this study we aimed to determine the incidence and mortality rate of CHD among patients admitted to our Level 2-3 NICU between January 2014-December 2015. Materials and Methods The electronic patient records of all NICU patients in the study period were evaluated for the demographic features, clinical course and risk factors affecting the prognosis of newborns diagnosed with congenital heart disease. Data for detailed demographic features, antenatal diagnostic features, birthplace, clinical features at diagnosis, independent morbidity and mortality due to disease, renal failure, heart failure, other organ failure development), immunological and genetic conditions (Di George Syndrome related genetic sendroms) TORCH serology, medical treatments, angiographic catheter interventions, surgical procedure, timin of operation decision, mortality reasons and time were recorded. Patients were grouped according to echocardiography results and clinical presentations as normal, non-significant, significant, serious and critical. Premature infants with patent ductus arteriosus were grouped separately as hemodynamically significant and non- significant. All patients undergoing surgery for congenital heart disease were also evaluated according to the RACHS-1 classification. In this scoring system; It is aimed to predict the short term mortality of congenital heart surgeons in patients under 18 years of age. For the statistical analysis, SPSS (Statistical Package for Social Sciences) for Windows 16. 0 program was used. Numerical variables are given by normal distribution T-test and ANOVA; Those with no normal distribution were assessed with Mann-Whitney U Test and Cruswell Well, and the data were summarized using mean ± standard deviation and median (minimum-maximum) values. Categorical data were cross-tabulated and Chi square test or Fisher Exact test was performed. After the risk factors were determined, logistic regression analysis was performed and analyzed by applying multivariate regression analysis (full model, forward and backward step-wise selection) to the parameters found to be significant. Values of p <0.05 were considered significant. Data analyzes were carried out at Ege University Faculty of Medicine Biostatistics Department. Results When the electronic patient records of 1,650 patients who were admitted to Ege University Medical Faculty Children's Hospital Neonatal Intensive Care Unit between January 2014 and December 2015 were examined; 869 (% 52-869 / 1650) patients were examined echocardiographically. Of the eight hundred and sixty-nine echocardiographic examinations, 144 (16.5% - 144/869) were normal; the remaining 725 (83.4%) were found to be abnormal. When the echocardiographic findings of the anomaly were examined, 117 (16.1 % -117/725%) of these were isolated PDA cases detected in preterm infants; And the remaining 608 (83%) patients had congenital heart disease. Significant / severe / critical CHD incidence in NICU clinic was 5.2 % (87/1650) and the mortality rate 37% (33/97) in this group. Among CDH group; nine patients underwent angiography, and 53 patients were operated. Antenatal diagnosis, not being able to be operated, need for mechanical ventilation, postoperative arrythmia were seen more frequently in CDH patients who died in the study period. When all factors were considered the diagnosis of genetic syndromes and postoperative arrythmia were the most important factors related to mortality. Discussion and Conclusion The incidence of CDH in our NICU is similar to the data reported in the literature. Mortality related to CDH is most commonly seen in patients with HLHS. As the difficulty of the surgical procedure increase; the mortality rates increased as expected. The relation of antenatal diagnosis with higher mortality may be related to the our hospital's position as being a large perinatal center receiving most complicated patients inutero. The evaluation of CHD patients for genetic diseases carry importance for prediction of mortality. The stabilization of CDH patients before surgery should be better provided by evoiding mechanical ventilation if possible. All postoperative patients must be closely followed for postoperative arrhtmias.