Newborn Infant – ABC CARDIOL

IJCS

Editorial

Is Pulse Oximetry a Reliable Method for Screening for Critical Congenital Heart Disease in Asymptomatic Neonates at 35 Weeks or More of Gestation?

Congenital cardiovascular malformations (CCVMs) are structural abnormalities of the heart or blood vessels present during fetal life and at birth. From 2010 to 2017, the incidence of CCVMs was estimated at 9.4 cases per 1,000 live births in countries in Southeast Asia and the Northern Hemisphere. During the same period, rates in Brazil ranged from 9.7 (in the northern region) to 62.8 (in the southeastern region) per 1,000 live births, and similar values have been reported by the Global Burden of Disease. Variability in the incidence of CCVMs is explained by diagnostic challenges arising from its broad clinical spectrum, which ranges from asymptomatic to symptomatic heart disease with associated risk of mortality. Approximately 25% of all patients with CCVMs are considered critical and require intervention within the first year of life because of the life-threatening nature of CCVMs and the significant dependence on hospital-based medical care.^,

Congenital malformations are the second leading cause of death in children under 1 year of age and the third leading cause of death in people under 20 years of age in the last decade in Brazil.^,, Among these malformations, CCVMs account for nearly 50% of malformation-related deaths.^,,, Despite their high incidence and significant impact on mortality, CCVMs are deemed preventable causes of death since early therapeutic intervention could alter their outcome. The high mortality rate of CCVMs is due to the lack of prenatal and perinatal diagnoses, which hinders or delays effective treatment and results in death.^,,-

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IJCS

Original Article

Congenital Heart Disesase: A Retrospective Analysis from a Tertiary Referral Centre in Portugal

Diogo Faim et al. Joaquim Tiago Rui Castelo Andreia Francisco … Rosa Alves António Pires

Abstract

Background:

Congenital heart disease is the leading cause of mortality among all congenital malformations.

Objectives:

To evaluate the incidence of congenital heart diseases in a central maternity hospital in Portugal from January 2003 to December 2018 and to determine survival in the first year of life.

Methods:

Retrospective analysis of newborns diagnosed with congenital heart diseases within 72 hours after birth. Malformations were divided according to pathophysiology. Cumulative survival analysis was performed by the Kaplan-Meier test. Stastical significance was set at p <0.05.

Results:

A total of 297 newborns with cardiac malformation was recorded among 47,198 live births (incidence of 6:1000), 16% associated with extra-cardiac disease. The most frequent congenital heart diseases were left-to-right shunt lesions (n = 216), followed by cyanotic (n = 41), acyanotic obstructive (n = 31) and miscellaneous (n = 9). Seventy (24%) patients had prenatal diagnosis, 88% of them cyanotic defects, and a positive association was found between prenatal diagnosis and mortality (p <0.001). Coarctation of the aorta was associated with gestational diabetes (p = 0.014). Atrial septal defect was more common in females (p = 0.02). Mortality rate due to heart disease was 3.4%. Patients with cyanotic disease, 99%, 97%, 97%, respectively, for patients with left-to-right shunt lesions, and 97%, 97%,97% for those with obstructive lesion cases.

Conclusion:

The incidence of congenital heart disease was 6:1000, mostly left-to-right shunt lesions. Heart disease accounted for only half of deaths, and cyanotic diseases have a high nonspecific mortality rate.