Pasierb Michele M, Peñalver Josiah M, Vernon Margaret M, Arya Bhawna
Division of Pediatric Cardiology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington.
Congenit Heart Dis. 2018 Jul;13(4):571-577. doi: 10.1111/chd.12611. Epub 2018 Jun 25.
Accurate prenatal diagnosis of congenital heart disease (CHD) allows for appropriate delivery and postnatal management. Geographic constraints limit access to fetal cardiology subspecialists. In our approach, general pediatric cardiologists are first line in regional prenatal cardiac screening. We aim to demonstrate the utility of this approach in diagnosing CHD requiring cardiac interventions within 30 days of life.
This is a retrospective review of fetal echocardiograms performed at Seattle Children's Hospital regional cardiology sites (SCH-RC) from December 2008 to December 2015. Referrals to Seattle Children's Hospital Prenatal Program (SCH-PNP) were evaluated for referral timing, indication, diagnostic accuracy, and postnatal care. Diagnostic accuracy was determined using the initial postnatal echocardiogram as the gold standard. Major discrepancy was defined as one resulting in change in surgical management.
Of 699 fetuses evaluated at regional sites throughout Washington and Alaska, a small subset (n = 48; 6.9%) required referral to SCH-PNP. Need for relocation was confirmed in 31 subjects, of which 27 required cardiac intervention within 30 days of life. Of those not referred to SCH-PNP (n = 643, 91.9%), none required neonatal cardiac intervention. There were 22 regional diagnostic discrepancies (31% major, 7% minor). Referral to SCH-PNP improved diagnostic accuracy (2% major, 0% minor).
Regional prenatal cardiac screening demonstrated 100% sensitivity and 98.9% specificity for identifying critical CHD. Utilizing regional pediatric cardiologists as first line in prenatal screening in geographically remote regions may improve access to care and outcomes in neonates with critical CHD while improving resource utilization.
先天性心脏病（CHD）的准确产前诊断有助于进行适当的分娩和产后管理。地理限制使得胎儿心脏病专科医生的可及性受限。在我们的方法中，普通儿科心脏病专家是区域产前心脏筛查的一线人员。我们旨在证明这种方法在诊断出生后30天内需要心脏干预的CHD方面的效用。
这是一项对2008年12月至2015年12月在西雅图儿童医院区域心脏病学站点（SCH-RC）进行的胎儿超声心动图检查的回顾性研究。对转诊至西雅图儿童医院产前项目（SCH-PNP）的病例进行了转诊时机、指征、诊断准确性和产后护理方面的评估。诊断准确性以出生后的首次超声心动图检查作为金标准来确定。重大差异定义为导致手术管理改变的差异。
在华盛顿州和阿拉斯加各地的区域站点评估的699例胎儿中，一小部分（n = 4 8；6.9%）需要转诊至SCH-PNP。31例患者被确认需要转诊，其中27例在出生后30天内需要心脏干预。在未转诊至SCH-PNP的患者中（n = 643，91.9%），无人需要新生儿心脏干预。存在22例区域诊断差异（31%为重大差异，7%为微小差异）。转诊至SCH-PNP提高了诊断准确性（重大差异2%，微小差异0%）。
区域产前心脏筛查在识别严重CHD方面显示出100%的敏感性和98.9%的特异性。在地理偏远地区将区域儿科心脏病专家作为产前筛查的一线人员，可能会改善患有严重CHD的新生儿的医疗可及性和治疗结果，同时提高资源利用效率。
