Arya Bhawna, Hammoud Miza Salim, Toth Andrew J, Woo Joyce, Campbell Matthew, Patel Angira, Edwards Lindsay A, Freud Lindsay, Gandhi Rupali, Krishnan Anita, Peyvandi Shabnam, Pinto Nelangi, Ronai Christina, Tejtel Kristen Sexson, Moon-Grady Anita, Donofrio Mary T, Srivastava Shubhika, Karamlou Tara
Department of Pediatrics Seattle Children's Hospital and the University of Washington School of Medicine Seattle WA USA.
Division of Pediatric Cardiac Surgery, Heart, Vascular & Thoracic Institute Cleveland Clinic Cleveland OH USA.
J Am Heart Assoc. 2025 May 6;14(9):e037079. doi: 10.1161/JAHA.124.037079. Epub 2025 May 2.
Fetal echocardiography is the mainstay of prenatal diagnosis of congenital heart disease. The COVID-19 pandemic led to shifts in triage of prenatal services. Our objective was to evaluate the impact of COVID-19 restrictions on prenatal diagnosis, surgical outcomes, and disparities in neonatal critical congenital heart disease (CCHD) management in the United States during the pandemic's first year.
A multi-institutional retrospective cohort study compared neonatal CCHD outcomes (requiring surgery within 60 days of birth) 1 year prior (prepandemic era) and during the peak pandemic era, supplemented by a Fetal Heart Society survey assessing regional practice changes. Data on prenatal diagnosis, demographics, outcomes, and 2020 state Area Deprivation Index were analyzed using Wilcoxon rank sum and χ tests. The survey, completed by 72 fetal cardiologists from 9 US census regions, showed 75% of institutions implemented restrictions by March 2020, affecting triage, referrals, and number of prenatal cardiology visits. Compared with CCHD neonates born prepandemic (n=4637), those born during the pandemic (n=1806) had a higher proportion of prenatal diagnosis (66% versus 63%, <0.05). There were no significant differences in complications or mortality, but pandemic-era neonates had longer hospital stays. During the pandemic, CCHD neonates had a more disadvantaged Area Deprivation Index and had surgery at hospitals located in more advantaged regions.
Although pandemic-driven care delivery adjustments affected perinatal cardiology referrals and triage, prenatal diagnosis, perioperative outcomes, and survival remained robust. The management of CCHD demonstrates health care resilience, maintaining core prenatal and perioperative care. Regional variations highlight the need for targeted strategies to address disparities during health care crises.
胎儿超声心动图是先天性心脏病产前诊断的主要手段。2019冠状病毒病（COVID-19）大流行导致产前服务的分诊发生变化。我们的目标是评估COVID-19限制措施对大流行第一年美国新生儿重症先天性心脏病（CCHD）管理中的产前诊断、手术结果和差异的影响。
一项多机构回顾性队列研究比较了大流行前1年（大流行前时代）和大流行高峰期新生儿CCHD结局（出生后60天内需要手术），并辅以胎儿心脏协会的一项调查，评估区域实践变化。使用Wilcoxon秩和检验和χ检验分析产前诊断、人口统计学、结局和2020年州地区贫困指数的数据。该调查由来自美国9个人口普查区域的72名胎儿心脏病专家完成，结果显示，到2020年3月，75%的机构实施了限制措施，影响了分诊、转诊和产前心脏病就诊次数。与大流行前出生的CCHD新生儿（n=4637）相比，大流行期间出生的新生儿（n=1806）产前诊断的比例更高（66%对63%，P<0.05）。并发症或死亡率没有显著差异，但大流行时代的新生儿住院时间更长。在大流行期间，CCHD新生儿的地区贫困指数更为不利，且在更具优势地区的医院接受手术。
尽管大流行导致的医疗服务调整影响了围产期心脏病转诊和分诊，但产前诊断、围手术期结局和生存率仍然良好。CCHD的管理显示了医疗保健的恢复力，维持了核心的产前和围手术期护理。区域差异凸显了在医疗保健危机期间制定针对性策略以解决差异的必要性。
