Article Text

Download PDFPDF
Outcomes of neonatal critical congenital heart disease: results of a prospective registry-based study from South India
  1. Deepa Sasikumar1,
  2. Mukund A Prabhu2,
  3. Renu Kurup3,
  4. Edwin Francis4,
  5. Sobha Kumar5,
  6. Sindhu Thekkile Gangadharan6,
  7. Krishnamoorthy Kavasseri Mahadevan1,
  8. Sivasubramanian Sivasankaran1,
  9. Raman Krishna Kumar7
  1. 1Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
  2. 2Department of Cardiology, Kasturba Medical College, Manipal. Manipal Academy of Higher Education, Manipal, Karnataka, India
  3. 3Department of Pediatric Cardiology, Malabar Institute of Medical Sciences, Calicut, Kerala, India
  4. 4Department of Pediatric Cardiology, Aster Kochi, Thiruvananthapuram, India
  5. 5Pediatrics, Trivandrum Medical College, Thiruvananthapuram, Kerala, India
  6. 6Pediatrics, Government Medical College Kozhikode, Kozhikode, Kerala, India
  7. 7Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Cochin, India
  1. Correspondence to Dr Deepa Sasikumar, Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India; deepaskumar{at}


Objectives Congenital heart disease (CHD) is now a leading contributor of infant and neonatal mortality in many low/middle-income countries including India. We established a prospective neonatal heart disease registry in Kerala to understand presentation of CHD, proportion of newborns with critical defects who receive timely intervention, outcomes at 1 month, predictors of mortality and barriers to timely management.

Methods The congenital heart disease registry for newborns (≤28 days) in Kerala (CHRONIK) was a prospective hospital-based registry involving 47 hospitals from 1 June 2018 to 31 May 2019. All CHDs, except small shunts with a high likelihood of spontaneous closure, were included. Data on demographics, complete diagnosis, details of antenatal and postnatal screening, mode of transport and distance travelled and need for surgical or percutaneous interventions and survival were collected.

Results Of the 1474 neonates with CHD identified, 418 (27%) had critical CHD, 22% of whom died at 1 month. Median age at diagnosis of critical CHD was 1 (0–22) day. Pulse oximeter screening identified 72% of critical CHD and 14% were diagnosed prenatally. Only 8% of neonates with duct-dependent lesions were transported on prostaglandin. Preoperative mortality accounted for 86% all deaths. On multivariable analysis, only birth weight (OR 2.7; 95% CI 2.1 to 6.5; p<0.0005) and duct-dependent systemic circulation (OR 6.43; 95% CI 5 to 21.8, p<0.0005) were predictive of mortality.

Conclusions While systematic screening, especially pulse oximetry screening, enabled early identification and prompt management of a significant proportion of neonates with critical CHD, important health system challenges like low use of prostaglandin need to be overcome to minimise preoperative mortality.

  • Cardiology
  • Child Health
  • Epidemiology
  • Healthcare Disparities
  • Neonatology

Data availability statement

Data are available upon reasonable request.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon reasonable request.

View Full Text


  • Contributors DS, MP, SS and RKK have made substantial contributions to the design of the work. EF, SK and STG have made contributions to acquisition, analysis and interpretation of data for the work. DS and RKK have drafted the work and revised it. DS is the gurarantor.

  • Funding This work was supported by the Cardiology Society of India (Kerala Chapter) (number: ECR/252/Indt/KL/2015/RR-18/02).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.