This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Bartlett, J. M.
Right arrow Articles by Newburger, J. W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bartlett, J. M.
Right arrow Articles by Newburger, J. W.
Related Collections
Right arrow Heart & Blood Vessels
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?
PEDIATRICS Vol. 113 No. 4 April 2004, pp. e335-e340

ELECTRONIC ARTICLE

Effect of Prenatal Diagnosis on Outcomes in D-Transposition of the Great Arteries

Jodi M. Bartlett, RN, BSN*, David Wypij, PhD*,{ddagger},§,||, David C. Bellinger, PhD, MSc,#, Leonard A. Rappaport, MD§,**, Linda J. Heffner, MD, PhD{ddagger}{ddagger},§§, Richard A. Jonas, MD||,¶¶ and Jane W. Newburger, MD, MPH*,§

* Departments of Cardiology
Neurology
** Medicine
|| Cardiovascular Surgery
{ddagger} Clinical Research Program, Children’s Hospital Boston, Boston, Massachusetts
{ddagger}{ddagger} Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts
§ Departments of Pediatrics
# Neurology
§§ Obstetrics and Gynecology
¶¶ Surgery, Harvard Medical School, Boston, Massachusetts
|| Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts

Background. By decreasing preoperative morbidity, prenatal diagnosis could improve neurodevelopmental outcomes in infants with critical congenital heart disease. We explored the impact of prenatal diagnosis on perinatal and perioperative variables and on outcomes at 1 year of age.

Methods. We analyzed a database of children enrolled in prospective studies on surgical support techniques from 1988 to 2000. Selection criteria included a diagnosis of D-transposition of the great arteries with intact ventricular septum or ventricular septal defect, no extracardiac congenital anomalies, birth weight >2.3 kg, and repair by arterial switch procedure.

Results. Of 346 patients at enrollment, 25 had a prenatal diagnosis, and 321 did not. Children with prenatal diagnosis, compared with those without, had a lower likelihood of birth by spontaneous labor, lower birth weights, lower Apgar 5 scores, a higher rate of preoperative endotracheal intubation, and surgery at a younger age. They tended to have a lower incidence of fetal distress during labor. At 1 year of age, 272 patients were tested with the Psychomotor Development Index and Mental Development Index of the Bayley Scales. Mean z scores were similar in those with and without prenatal diagnosis for both Psychomotor Development Index (–0.92 ± 0.93 vs –0.88 ± 1.05) and Mental Development Index (–0.29 ± 1.13 vs –0.41 ± 0.93).

Conclusions. Infants with D-transposition of the great arteries with and without prenatal diagnosis differed with respect to perinatal and perioperative variables, but their development at 1 year of age was similar. Future studies should include a greater number of children with prenatal diagnosis and a variety of congenital heart lesions.

Key Words: congenital heart disease • transposition of the great arteries • cardiac surgery • child development • prenatal diagnosis

Abbreviations: CHD, congenital heart disease • D-TGA, D-transposition of the great arteries • IVS, intact ventricular septum • VSD, ventricular septal defect • PDI, Psychomotor Development Index • MDI, Mental Development Index • SD, standard deviation

Received for publication May 9, 2003; Accepted Dec 8, 2003.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 Circ Cardiovasc Qual OutcomesHome page
V. Peiris, T. P. Singh, W. Tworetzky, E. C. Chong, K. Gauvreau, and D. W. Brown
Association of Socioeconomic Position and Medical Insurance With Fetal Diagnosis of Critical Congenital Heart Disease
Circ Cardiovasc Qual Outcomes, July 1, 2009; 2(4): 354 - 360.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
D. J. Licht, D. M. Shera, R. R. Clancy, G. Wernovsky, L. M. Montenegro, S. C. Nicolson, R. A. Zimmerman, T. L. Spray, J. W. Gaynor, and A. Vossough
Brain maturation is delayed in infants with complex congenital heart defects.
J. Thorac. Cardiovasc. Surg., March 1, 2009; 137(3): 529 - 536.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
R.-K. R. Chang, M. Gurvitz, and S. Rodriguez
Missed Diagnosis of Critical Congenital Heart Disease
Arch Pediatr Adolesc Med, October 1, 2008; 162(10): 969 - 974.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
G. Wernovsky
Improving neurologic and quality-of-life outcomes in children with congenital heart disease: Past, present, and future
J. Thorac. Cardiovasc. Surg., February 1, 2008; 135(2): 240 - 242.
[Full Text] [PDF]

Home page
 J Ultrasound MedHome page
J. P. McGahan, A. J. Moon-Grady, A. Pahwa, D. Towner, L. Rhee-Morris, E. O. Gerscovich, and M. Fogata
Potential Pitfalls and Methods of Improving In Utero Diagnosis of Transposition of the Great Arteries, Including the Baby Bird's Beak Image
J. Ultrasound Med., November 1, 2007; 26(11): 1499 - 1510.
[Abstract] [Full Text] [PDF]