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Moras P, Zarfati A, Bagolan P, Conforti A, Toscano A, Iacobelli BD. Anorectal malformations (ARM) and VACTERL association and severity of congenital heart diseases (CHD): Experience of 396 consecutive patients in a tertiary center. Pediatr Neonatol 2024; 65:381-385. [PMID: 38163746 DOI: 10.1016/j.pedneo.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/05/2023] [Accepted: 08/24/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE Congenital heart diseases (CHD) are the most frequently associated anomalies with anorectal malformations (ARM). Nevertheless, many specific aspects of CHD in ARM patients have yet to be studied. The aims of this study were to evaluate the prevalence and distribution of CHD in neonates-infants with ARM, and to explore whether the severity of ARM, and the presence of VACTERL association, had an impact on CHD rate, severity, and timing at first cardiac surgery. STUDY DESIGN All consecutive newborn-infants with ARM managed in our tertiary center (January-1999; December-2021) were collected from a prospective database and retrospectively analyzed. Prevalence and distribution of CHD in ARM patients were assessed. Patients were divided into groups depending on ARM severity and presence of VACTERL association. Pairwise comparison for CHD prevalence, severity, and timing at first cardiac surgery was performed between groups. RESULTS Of 396 ARM patients identified, those with severe ARM showed a higher number of overall CHD compared to patients with non-severe ARM (36.7 % vs. 25.2 %, p = 0.032). VACTERL + patients had a significantly higher prevalence of CHD (73.4 % vs. 16.4 %; p <0.001) and major CHD (51.7 % vs. 26.9 %; p = 0.008) when compared with VACTERL-patients. Furthermore, VACTERL + patients underwent first cardiac surgery at a significantly younger age than VACTERL-patients (5.2 ± 15.2 months vs. 11.9 ± 6.3, p = 0.039). CONCLUSIONS Patients with severe ARM had a higher number of CHD compared to patients with non-severe ARM. VATERL + patients had significantly more CHD and more severe CHD than VACTERL-patients. Early screening for CHD is strongly recommended in all newborns diagnosed with ARM before surgery. LEVEL OF EVIDENCE III retrospective comparative study.
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Affiliation(s)
- Patrizio Moras
- Perinatal Cardiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Angelo Zarfati
- Neonatal Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - Pietro Bagolan
- Neonatal Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Andrea Conforti
- Neonatal Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandra Toscano
- Perinatal Cardiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Faultersack J, Johnstad CM, Zhang X, Greco M, Hokanson JS. Follow-Up of Secundum ASD, Muscular VSD, or PDA Diagnosed During Neonatal Hospitalization. Pediatr Cardiol 2024:10.1007/s00246-024-03537-2. [PMID: 38907870 DOI: 10.1007/s00246-024-03537-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 06/01/2024] [Indexed: 06/24/2024]
Abstract
The ideal follow-up of neonates who have a secundum atrial septal defect (ASD), muscular ventricular septal defect (VSD), or patent ductus arteriosus (PDA) remains uncertain. Newborns with findings limited to a secundum ASD, muscular VSD, and/or PDA on their neonatal hospitalization discharge echocardiogram and at least one outpatient follow-up echocardiogram performed between 9-1-17 and 9-1-21 were evaluated and patient follow-up assessed through 9-1-23. 95 infants met inclusion criteria. 43 infants had a secundum ASD, 41 had a muscular VSD, and 54 had a PDA at newborn hospital discharge. 39/95 had more than one intracardiac shunt. 56 were discharged from care, 26 were still in follow-up and 13 were lost to recommended follow-up. No patients received intervention during the follow-up period of 2 to 6 years. Of the 43 infants with a secundum ASD, 16 (37.2%) had demonstrated closure of the ASD, and 13 (30.2%) were discharged from care with an ASD < 3.5 mm in diameter. 3/43 infants with secundum ASD had a defect with a diameter of more than 5 mm at their last echocardiogram. No infant discharged from their neonatal hospitalization with a secundum ASD, muscular VSD, or PDA needed any intervention from 2 to 6 years of follow-up. Ongoing follow-up with echocardiography of those infants with a secundum ASD is of greater value than of those with muscular VSD or PDA.
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Affiliation(s)
- Jacob Faultersack
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Xiao Zhang
- Division of Pediatric Cardiology, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, H6/516C, 600 Highland Ave., Madison, WI, 53792, USA
| | - Margaret Greco
- Division of Pediatric Cardiology, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, H6/516C, 600 Highland Ave., Madison, WI, 53792, USA
| | - John S Hokanson
- Division of Pediatric Cardiology, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, H6/516C, 600 Highland Ave., Madison, WI, 53792, USA.
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Faultersack J, Johnstad C, Zhang X, Greco M, Hokanson J. Follow-up of Secundum ASD, Muscular VSD, or PDA Diagnosed During Newborn Hospitalization. RESEARCH SQUARE 2024:rs.3.rs-3871102. [PMID: 38313288 PMCID: PMC10836113 DOI: 10.21203/rs.3.rs-3871102/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Background The ideal follow-up of neonates who have a secundum atrial septal defect (ASD), muscular ventricular septal defect (VSD) or patent ductus arteriosus (PDA) remains uncertain. Methods Newborns with findings limited to a secundum ASD, muscular VSD and/or PDA on their last birth hospital echocardiogram and at least one outpatient follow-up echocardiogram performed between 9-1-17 and 9-1-21 were evaluated and patient follow-up assessed through 9-1-23. Results 95 babies met inclusion criteria. 43 babies had a secundum ASD, 41 had a muscular VSD and 54 had a PDA at newborn hospital discharge. 39/95 had more than one intracardiac shunt. 56 were discharged from care, 26 were still in follow-up and 13 were lost to recommended follow-up.No patients required intervention during the follow-up period of 2 to 6 years. Of those 43 with a secundum ASD 16 (37.2%) had demonstrated closure of the ASD and 13 (30.2%) were discharged from care with and ASD < 3.5 mm in diameter. 3/43 infants with secundum ASD had a defect large enough to easily warrant further follow-up. Conclusion Even in this group who had early clinical follow-up recommended by a pediatric cardiologist, no baby discharged from their birth hospitalization with a secundum ASD, muscular VSD or PDA needed any intervention from 2 to 6 years of follow-up. Ongoing follow-up with echocardiography of those infants with a secundum ASD is of greater value than of those with muscular VSD or PDA.
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Papunen I, Poutanen T, Ylänen K. Major congenital heart defects are rarely diagnosed after newborns' hospital discharge with modern screening. Acta Paediatr 2024; 113:143-149. [PMID: 37522553 DOI: 10.1111/apa.16928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/16/2023] [Accepted: 07/28/2023] [Indexed: 08/01/2023]
Abstract
AIM Our aim was to assess undiagnosed congenital heart defects (CHD) after newborns' hospital discharge in patients with a murmur or CHD suspicion, to find out the signs that predict CHDs and to estimate the costs of the examinations. METHODS We reviewed retrospective medical records of patients (n = 490) referred for the evaluation of CHD suspicion during 2017-2018. RESULTS The median age of the patients was 2.5 (IQR 0.5-7.4) years. Sixty-three (13%) patients had an abnormal echocardiography. Neither ductal-dependent nor cyanotic CHDs were found. Cardiac interventions were performed for 14 out of 63 (22%) patients. Clinical signs indicating CHDs were murmur grade ≥3 (10/11 [91%] vs. 53/479 [11%], p < 0.001) and harsh murmur (15/44 [34%] vs. 48/446 [11%], p < 0.001). Abnormal electrocardiography did not indicate CHD (8/40 [20%] vs. 55/447 [12%], p = 0.165). The total cost of the examinations was 259 700€. The share of the cost of studies assessed as benign was 59%. CONCLUSION Only a few CHDs were found after newborn hospital discharge among patients who received foetal and newborn screening and were examined due to CHD suspicion. The high number of benign murmurs in children leads to many referrals, resulting in unnecessary healthcare costs.
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Affiliation(s)
- I Papunen
- Tampere Center for Child, Faculty of Medicine and Health Technology, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
| | - T Poutanen
- Tampere Center for Child, Faculty of Medicine and Health Technology, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - K Ylänen
- Tampere Center for Child, Faculty of Medicine and Health Technology, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland
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Gaffar S, Siassi B, Cayabyab R, Ebrahimi M, Barton L, Uzunyan M, Ramanathan R. Outcomes of patent foramen ovale greater than 3 mm at birth in extremely low birthweight infants. BMC Pediatr 2023; 23:293. [PMID: 37322472 PMCID: PMC10268431 DOI: 10.1186/s12887-023-04119-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Foramen ovale (FO) is an obligate fetal shunt that typically resolves after birth, although patency throughout life is not uncommon. The natural history of patent FO (PFO) is known in term infants, but less is known about its course in extremely preterm infants. We describe the echocardiographic changes in FO size from birth to discharge in extremely low birth weight (ELBW) infants in this retrospective study. METHODS Cohort was divided based on size of FO at birth. Size of FO at discharge was measured and evaluated relative to postnatal weight gain. Demographics and clinical outcomes were compared between the two groups. RESULTS Of the 54 ELBW infants, 50 were born with FO less than 3 mm in diameter (small), and 4 were born with FO greater than 3 mm (large). Of small defects, the majority (44/50, 88%) did not increase in size with weight gain, and minority (6/50, 12%) increased in size, and three of these 6 patients, FO grew to be slightly larger than 3 mm. In contrast, all large defects (4 of 4, 100%) nearly doubled in size with postnatal growth. These 4 ELBW infants with enlargement of FO had a flap valve evident on echocardiogram obtained prior to discharge, and subsequently closed on outpatient follow-up echocardiograms, although time to resolution was variable (6 months - 3 years). One infant had presumptive resolution because of the presence of flap valve. CONCLUSION No maternal or neonatal demographic characteristics were predictive of FO enlargement, although, demonstrable flap valve on discharge echocardiogram correlated with resolution of FO on outpatient follow-up echocardiogram. Therefore, based on our data, we recommend that ELBW infants born with large FO should have echocardiographic re-evaluation of the atrial septal opening prior to discharge, to specify the presence of a flap valve or lack thereof, which is an important detail that can help a neonatologist determine the need for outpatient cardiac follow-up.
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Affiliation(s)
- Sheema Gaffar
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA.
| | - Bijan Siassi
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA
| | - Rowena Cayabyab
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA
| | - Mahmood Ebrahimi
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA
| | - Lorayne Barton
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA
| | - Merujan Uzunyan
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA
- Division of Cardiology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, Los Angeles, CA, USA
| | - Rangasamy Ramanathan
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA
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