Background Antenatal detection of cardiac malformation is currently 35%.¹ Although this has been steadily improving, still majority of cardiac malformations present unexpectedly in the postnatal period. Over recent years, Neonatologists have acquired echocardiographic skills to make diagnosis locally, thus reducing unnecessary transfer of patients to cardiac centre for diagnostic evaluation alone.

Aims and Methods: We audited all acute inpatient referrals to our regional cardiac centre at Liverpool over 2.5 years period from Mar-2008 – Oct-2010. Neonatal Badger dataset was used to identify all cardiac transfers to Liverpool. Patient notes were reviewed to look at the antenatal diagnosis, clinical presentation, local echocardiographic diagnosis, subsequent diagnosis concordance at cardiac centre and their outcomes.

Results There were 15 transfers to regional cardiac centre in the audit period. Echocardiography was performed in 14/15 patients (93%) locally. Of these 14 patients, 2 patients were referred semi-electively for PDA ligation and both were confirmed by cardiologist to be suitable for ligation. Of the remaining 13 patients, local echocardiographic findings were concordant with cardiologist’s findings in 12 patients (92%). One patient suspected to have congenital cyanotic heart disease turned out to have structurally normal heart and was treated as PPHN (discordance rate 8%).

Antenatal diagnosis was made in 5/13(38%) which is in keeping with national statistics.¹

Excluding patients with PDA, 10/12 (83%) babies had abnormal saturations (<95%) and 2/12 (17%) had normal saturations (> 95%). Both the babies with normal saturations had aortic arch abnormalities.

3 babies had inoperable cardiac conditions and 1 baby had underlying severe chromosomal anomaly and multiple congenital malformations leading to palliative care plans.

Conclusions Our attempt at initial cardiac diagnosis was 93% compared to 41% and correct cardiac diagnosis concordance from our unit was 92% compared to 64% in the study published from Embrace transport service.2

Our concordance rates are comparable to similar work published from our local regional Neonatal unit.³

References

1. www.ccad.org.uk/congenital – updated 2012.

2. Arch Dis Child 2012; 97:A130-A131.

3. Arch Dis Child Fetal Neonatal Ed 2003; 88:F287–F291.