RT Journal Article
SR Electronic
T1 Outcomes of neonatal critical congenital heart disease: results of a prospective registry-based study from South India
JF Archives of Disease in Childhood
JO Arch Dis Child
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP 889
OP 894
DO 10.1136/archdischild-2023-325471
VO 108
IS 11
A1 Sasikumar, Deepa
A1 Prabhu, Mukund A
A1 Kurup, Renu
A1 Francis, Edwin
A1 Kumar, Sobha
A1 Gangadharan, Sindhu Thekkile
A1 Mahadevan, Krishnamoorthy Kavasseri
A1 Sivasankaran, Sivasubramanian
A1 Kumar, Raman Krishna
YR 2023
UL http://adc.bmj.com/content/108/11/889.abstract
AB 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.Data are available upon reasonable request.