Aims To assess current practice among paediatricians with expertise in cardiology (PEC’s) and review our own practice in order to evaluate the validity of current recommendations and to recommend change to practice.
Methods A nationwide online survey of PEC’s and their practice. We broadly grouped abnormalities into those requiring a catheter procedure as a marker of moderate CHD and those requiring surgery as more significant CHD. We the audited our own outcomes to assess the validity of screening recommendations.
Results 39 responses
In evaluation of murmur, 83% of PEC clinicians would see in clinic and 51% perform an echo even if the murmur had resolved. Only 27/39 (69.2%) can perform the clinical evaluation within 4 weeks due to lack of clinic capacity. Our survey demonstrated that the likelihood of arranging follow up increases with severity of congenital heart abnormality and the absence of detailed antenatal assessment. Audit of our practice showed a low pick up rate of significant congenital heart disease when screening is based on familial risk alone.
Conclusions Practice varies among PEC clinicians in the UK. Most clinicians are unable to review those with heart murmurs within the recommended 4 weeks due to lack of capacity. Most congenital heart disease has a low recurrence risk. However, left sided obstructive lesions, e.g. critical AS, have a greater recurrence risk and specific gene abnormalities are well documented. Furthermore, these lesions are more likely to be clinically silent with acute, severe presentation at the time of closure of the ductus. Our experience has demonstrated that the pick-up rate for all infants with a family history of CHD is relatively low and our survey demonstrated that many clinicians are not reviewing patients in a timely manner. We recommend selective screening by postnatal echo of patients with a family history of congenital heart disease in the context of a normal detailed fetal anomaly scan and a normal NIPE examination to include only those infants with a family history of CHD with a high recurrence risk.
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