Neonatal echocardiogram in duodenal obstruction is unnecessary after normal fetal cardiac imaging.

作者信息

Stephens Caroline Q, Dukhovny Stephanie, Rowland Kathryn J, Hamilton Nicholas A

机构信息

Oregon Health & Science University, Department of Surgery, Division of Pediatric Surgery, Doernbecher Children's Hospital, Portland, OR, USA.

Oregon Health & Science University, Department of Obstetrics and Gynecology, Portland, OR.

出版信息

J Pediatr Surg. 2018 Nov;53(11):2145-2149. doi: 10.1016/j.jpedsurg.2018.04.039. Epub 2018 May 6.

DOI:10.1016/j.jpedsurg.2018.04.039

PMID:29866484

Abstract

BACKGROUND

Duodenal obstruction (DO) is associated with congenital cardiac anomalies that may complicate the delivery of anesthesia during surgical repair. As most infants undergo fetal ultrasounds that identify cardiac anomalies, our aim was to determine the utility of obtaining preoperative neonatal echocardiograms in all DO patients.

METHODS

We conducted a retrospective cohort study of all DO patients treated at two tertiary care children's hospitals between January 2005 and February 2016. Prenatal ultrasounds were compared to neonatal echocardiograms to determine concordance. Binomial exact analyses were used to estimate the negative predictive value (NPV) of prenatal imaging.

RESULTS

We identified 65 infants with DO. The majority of patients (93.8%) had prenatal ultrasounds, including twenty patients that underwent fetal echocardiogram. Fourteen (21.5%) were diagnosed with cardiac lesions in utero, and neonatal echocardiograms confirmed 12 lesions, without identifying any new lesions. No changes to anesthetic management were made because of cardiac lesions. The NPV of prenatal imaging was 100% (95% Confidence Interval: 91.0-100.0).

CONCLUSIONS

Neonatal echocardiogram is unlikely to identify new cardiac lesions in DO patients with negative fetal imaging and delays in surgical care are unwarranted.