Decreasing Mortality for STAT 4 and 5 Neonatal Heart Surgeries Concurrent With Improving Prenatal Detection: The Nevada Experience

Objective: Our objective was to investigate whether a relationship existed between our center’s STAT 4 and 5 category surgical mortality and general-population prenatal detection rates in Nevada. Methods: We identified patients who underwent STAT 4 and 5 neonatal index cardiovascular surgeries at our center between October 2012 and September 2021. Additionally, we calculated prenatal detection rates for each of the 9 retrospective study years. We used descriptive statistics and nonparametric testing, including the Spearman Rho correlation (R) and the Mann-Whitney U-tests, with a significant P-value set at < .05. Results: We identified 356 patients. We noted a statistically significant increasing trend in prenatal detection percentages (rho = 0.79, P = .01), concurrent with a statistically significant decreasing trend in surgical mortality (rho = −0.82, P = .007). Conclusions: Despite encouraging results, we could not establish a cause-and-effect relationship between concurrent decreased surgical mortality and increased prenatal detection rates for patients undergoing STAT 4 and 5 surgical procedures at our center.

[1]  W. Evans,et al.  Prenatal diagnosis of significant congenital heart disease and elective termination of pregnancy in Nevada , 2021, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[2]  C. Combs,et al.  Special Statement: Proposed Quality Metrics to Assess Accuracy of Prenatal Detection of Congenital Heart Defects. , 2020, American journal of obstetrics and gynecology.

[3]  A. Rothman,et al.  Detecting Critical Congenital Heart Disease in Nevada , 2019, World journal for pediatric & congenital heart surgery.

[4]  George R. Verghese,et al.  Prenatal Diagnosis Influences Preoperative Status in Neonates with Congenital Heart Disease: An Analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database , 2018, Pediatric Cardiology.

[5]  W. Walsh,et al.  A Novel, More Efficient, Staged Approach for Critical Congenital Heart Disease Screening , 2016, Journal of Perinatology.

[6]  M. Jacobs,et al.  Variation in Prenatal Diagnosis of Congenital Heart Disease in Infants , 2015, Pediatrics.

[7]  B. J. HOLLAND,et al.  Prenatal diagnosis of critical congenital heart disease reduces risk of death from cardiovascular compromise prior to planned neonatal cardiac surgery: a meta‐analysis , 2015, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[8]  S. Gilboa,et al.  Estimated Number of Infants Detected and Missed by Critical Congenital Heart Defect Screening , 2015, Pediatrics.

[9]  A. Galindo,et al.  Moving Towards Universal Prenatal Detection of Critical Congenital Heart Disease in Southern Nevada: A Community-Wide Program , 2015, Pediatric Cardiology.

[10]  T. Mondal,et al.  Fetal echocardiography assists in determining optimal delivery site. , 2014, Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC.

[11]  F. Mcauliffe,et al.  Routine obstetric ultrasound services. , 2013, Irish medical journal.

[12]  N. Silverman,et al.  Costs of prenatal detection of congenital heart disease. , 2011, The American journal of cardiology.

[13]  J. Hokanson,et al.  Missed congenital heart disease in neonates. , 2010, Congenital heart disease.

[14]  Sean M. O'Brien,et al.  An empirically based tool for analyzing mortality associated with congenital heart surgery. , 2009, The Journal of thoracic and cardiovascular surgery.

[15]  R. Chang,et al.  Missed diagnosis of critical congenital heart disease. , 2008, Archives of pediatrics & adolescent medicine.

[16]  W. Evans,et al.  Prenatal Detection of Congenital Heart Disease in Southern Nevada , 2007, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[17]  S. Yagel,et al.  Examination of the fetal heart by five short‐axis views: a proposed screening method for comprehensive cardiac evaluation , 2001, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.