Resolution of Postnatal Shock Before Open Heart Surgery in Neonates With Prenatal Diagnoses

Abstract

Background: The impact of a prenatal diagnosis (PreND) for congenital heart disease on outcomes after neonatal open heart surgery is undetermined. We hypothesized that PreND has a positive impact on surgical outcomes in terms of immediate postnatal intensive care, which may lead to a decreased risk of persistent shock before surgery.

Methods: Among the 949 neonates who underwent open heart surgery between January 2002 and December 2017, 655 patients (69.0%) were diagnosed prenatally (group-PreND) and 294 patients (31.0%) were diagnosed postnatally (group-PostND). Procedural complexity, incidence of postnatal shock (serum lactate >4.0 mmol/L or pH <7.2), hospitalization length of stay, duration of shock, resolution of shock, and in-hospital mortality were compared between the 2 groups.

Results: In group-PreND, the procedure-dependent comprehensive Aristotle score (10.8 vs 10.0, P < .001), incidence of extracardiac anomalies (13.0% vs 7.1%, P = .008), heterotaxy syndrome (3.8% vs. 1.0%, P = .021), and postnatal shock (244 of 655 [37.3%] vs 78 of 294 [26.5%], P = .001) were higher than in group-PostND. However, patients in group-PreND were hospitalized earlier after birth (0 day vs 5 days, P < .001), experiencing shorter duration of shock (5.3 hours vs 9.0 hours, P = .01), and, consequently, showing higher incidence of shock resolution (212 of 244 [87%] vs 52 of 78 [67%], P < .001). In-hospital mortality was comparable between the 2 groups (P = .070).

Conclusions: Postnatal shock is more frequently observed in group-PreND. However, prenatal awareness of the disease leads to immediate postnatal initiation of intensive care with shorter exposure to shock, leading to higher probability of shock resolution.