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18541

A 22 Year Review of Complex Congenital Heart Disease In Level III NICU

Friday, October 19, 2012
Room R02-R05 (Morial Convention Center)
Kirtikumar N. Upadhyay, MD1, Ramasubbareddy Dhanireddy, MD2 and Ajay J. Talati, MD2, (1)Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, (2)Department of Pediatrics and Ob- Gyn, University of Tennessee Health Science Center, Memphis, TN

Purpose:

Congenital anomalies and malformations are the leading causes of mortality in infants. The prevalence of complex congenital heart diseases (CCHD) in these infants is significant. State Department of Health and National Vital Statistics publish data regarding CCHD every few years, however, the data about incidence and mortality of CCHD with improved diagnostic abilities and management over last 2 decades is not clear. The purpose of our study was to evaluate the incidence and mortality of CCHD in neonates, born alive at our tertiary level III NICU.

Methods:

We conducted a retrospective database review of neonates born between August 1989 through Sept 2010. Neonates were eligible for study if they were born alive, admitted to the NICU for care and were diagnosed with congenital heart disease (CHD). CCHD was defined as cyanotic heart defects, heart diseases with single ventricle physiology, heart diseases with systemic hypo perfusion and congestive heart failure. We excluded those neonates who had acyanotic heart defects with no or mild respiratory distress. We also excluded babies with concurrent lethal anomalies of other organ systems.

Results:

Over a period of 22 years we had 107,088 live births, of which 24,221 were admitted in the NICU. Out of these, 811 (7.5 per 1000 live births) babies were diagnosed with CHD, of which 198 (1.8 per 1000 live births) babies had CCHD. Group 1 (1989-1999) had 423 (7.3 per 1000 live birth) babies with CHD while group 2 (2000-2010) had 388 (7.8 per 1000 live birth). 93 babies had CCHD in group 1 and 105 in group 2. 21 babies died in group 1 due to CCHD and 12 died in group 2 (p-0.054); of which 11 neonates died post operatively in group 1 and 5 neonates in group 2 (p-0.06). The table illustrates the comparison of incidence and mortality of individual CCHD between two groups.

CCHD

Group1

(1989-1999)

N=93

Group 2

(2000-2010)

N=105

Group 1

Mortality

N=21

Group 2

Mortality

N=12

TOF

15

20

 1

 3

TGA

11

 9

 2

 2

Hypoplastic Heart syndrome

20

17

10

 4

Ebstein

 3

 2

 0

 0

Coarctation

12

 9

 0

 0

A V Canal

 4

14

 1

 0

Truncus

 4

 3

 1

 0

Pul Atresia

 7

 7

 0

 1

Tricus atresia

 3

 5

 0

 0

DORV

 4

 6

 2

 1

Interrupted aortic arch/ Aortic atresia

 2

 1

 0

 1

TAPVR

 4

 5

 4

 0

Tumor of the heart

 3

 6

 0

 0

Cor Triatum

 1

 1

 0

 0

Conclusions:

The incidence of neonates born with all CHD and CCHD did not change significantly in the second decade. However, the mortality during the hospital stay of CCHD seem to improve, which may be due to improved post-operative survival over time.