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Potential benefits of prenatal diagnosis of TGA in Australia may be outweighed by the adverse effects of earlier delivery: likely causation and potential solutions
  1. Siva P Namachivayam1,2,3,4,
  2. Warwick Butt1,2,3,4,
  3. Christian Brizard3,4,5,
  4. Johnny Millar1,2,3,4,
  5. Jenny Thompson1,4,
  6. Susan P Walker6,7,
  7. Michael M H Cheung3,4,8
  1. 1Cardiac Intensive Care Unit, Royal Children's Hospital, Parkville, Victoria, Australia
  2. 2Department of Critical Care, The University of Melbourne—Parkville Campus, Melbourne, Victoria, Australia
  3. 3Department of Paediatrics, The University of Melbourne—Parkville Campus, Melbourne, Victoria, Australia
  4. 4Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
  5. 5Department of Cardiac Surgery, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  6. 6Department of Obstetrics and Gynaecology, The University of Melbourne—Parkville Campus, Melbourne, Victoria, Australia
  7. 7Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia
  8. 8Department of Cardiology, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  1. Correspondence to Dr Siva P Namachivayam, Cardiac Intensive Care Unit, Royal Children's Hospital, Parkville, VIC 3052, Australia; siva.namachivayam{at}rch.org.au

Abstract

Objective Prenatal diagnosis of transposition of great arteries (TGA) is expected to improve postoperative outcomes after neonatal arterial switch operation (ASO); however, published reports give conflicting results. We aimed to determine the association between prenatal diagnosis and early postoperative outcomes after neonatal ASO.

Methods Cohort study involving 243 newborns who underwent ASO (70% prenatally diagnosed) between 2010 and 2019. Multivariable regression was used to determine the association between prenatal diagnosis and (a) birth characteristics and (b) postoperative outcomes.

Results Gestational age and birthweight centile were lower and small-for-gestational-age more common (11.8% vs 1.4%) in those diagnosed prenatally. Among births which followed labour induction or prelabour caesarean, prenatal diagnosis was associated with earlier gestation at birth (mean (SD), 38.5 (1.6) vs 39.2 (1.4), p=0.01). Among births which followed spontaneous labour, prenatal diagnosis was associated with earlier gestation at labour onset (38.2 (1.8) vs 39.2 (1.4), p=0.01). Prenatal diagnosis was associated with longer postoperative mechanical ventilation (incidence rate ratio 1.74, 95% CI 1.37 to 2.21), intensive care (1.70, 1.31 to 2.21) and hospital length of stay (1.37, 1.14 to 1.66) after ASO. Gestational age mediated up to 60% of the effect of prenatal diagnosis on postoperative outcomes.

Conclusion Among newborns undergoing ASO for TGA, prenatal diagnosis is associated with poorer early postoperative outcomes. In addition to minimising iatrogenic factors (such as planned births) resulting in earlier births, evaluation of other dynamics following a prenatal diagnosis which may result in poor fetal growth and earlier onset of spontaneous labour is important.

  • cardiology
  • intensive care units, paediatric

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

http://dx.doi.org/10.1136/archdischild-2022-324861

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Contributors SPN conceptualised and designed the study, obtained data, had full access to the dataset and performed the analyses, drafted the initial manuscript and reviewed and revised the manuscript. SPN acts as guarantor of the study. MC conceptualised and designed the study, obtained data, drafted the initial manuscript and reviewed and revised the manuscript. JT obtained data, had access to the dataset, provided initial data merging and important intellectual content. KJM, WB, CB and SPW provided important intellectual content to the study and critically reviewed the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

    • Funding SPN is supported by a health professional research scholarship from the National Heart Foundation of Australia (award number 101003).

    • Disclaimer The conclusions, findings, opinions and views or recommendations expressed in this paper are strictly those of the author(s). They do not necessarily reflect those of CCOPMM.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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