Background and Aims Major congenital heart disease (CHD) is defined as CHD that needs operative or catheter based intervention in the first year of life. National institute of clinical excellence (NICE) in March 2008 recommended screening of outflow-tracts in addition to four-chamber view as part of the anomaly scan to improve CHD detection rates. We aimed to examine the clinical spectrum of antenatally and postnatally diagnosed major CHD in our institute pre- and post-introduction of NICE guideline.

Methods This is a retrospective review over six years from Jan 2006 to Dec 2011. Data was obtained from antenatal records, patient’s clinical and electronic records.

Results A total of 74 babies had major CHD diagnosed out of which 37 (50%) were diagnosed antenatally. Antenatal diagnosis pre- and post- NICE guidelines were 12/29 (41%)and 25/45 (55%) respectively as also termination of pregnancies with critical CHD doubled. Common postnatal presentations included cardiovascular collapse 4 (11%), cyanosis 8 (22%), murmurs 12 (32%), heart failure 5 (13.5%), faltering growth 5(13.5%). 4 babies were critically ill with severe acidosis and 3 needed intubation and ventilation prior to transfer to a tertiary unit. Median age at intervention for duct dependent lesions was 10 days and other major CHD was 5 months.

Conclusions Although antenatal screening methods have improved, a large proportion of babies with CHD are still undetected. Routine Pulse-oximetry screening has proved to be an effective screening adjunct in four large studies and hence should be considered as part of early neonatal examination.