Background

The incidence of PDA in<28weeks babies is 75%

Objectives

To review the medical management of PDA in extreme preterm babies born at early gestation of viability at 23 weeks in a tertiary Neonatal unit in UK.

Methods

All babies born at 23+0 to 23+6 weeks were included during the study period(Jan 2010- Dec 2014).Data was collected about PDA diagnosis and management from the medical notes and local neonatal database.Significant PDA was defined as on Echo: Duct size >1.5mm,left heart dilatation La:Ao (Left atrium:Aortic) ratio: >1.4,Pulsatile ductal flow pattern,Velocity max>2mm/s,diastolic retrograde flow in descending aorta. Ibuprofen was only drug used for medical management of PDA.

Results

21 babies born during the study period were reviewed,4 babies died before ECHO at age<24 hours,constituting 17 babies in the study. Mean PDA detection was at 5.5 days.Average PDA size was 2 mm(+/- 0.78 SD), significant duct size was measured in 82 % (14/17). Average LA-Ao ratio was 1.4(0.30 SD) and significant in 47%.10 babies required Ibuprofen treatment and 7 did not require and the mean age was 5.8 days for administering it.8 babies required 1 course (Dose 10, 5, 5 mg) and 2 babies required 2 courses,1 of which required surgical ligation.Treatment associated effects of altered renal functions and NEC in 1 baby each and thrombocytopenia in 2 babies.Other co-morbidities noted were IVH(9), CLD(11),NEC-confirmed(3).6/17 babies survived to discharge.

Conclusion

Medical management of PDA even from a single NICU is quite variable.The unit will be participating in a multicenter RCT to answer some of these uncertainties.

Background

Major Congenital Heart Disease (CHD) occurs in about 35/10,000 births.Despite advances in screening programme,up to 50% of major congenital heart diseases were still missed on fetal anomaly scans in UK.

Objectives

To identify missed cases of major congenital heart disease¹ which require immediate cardiac assessment and/or treatment within the first two weeks of a child’s life.

Methods

Babies born from 1^st January 2014- 31^st Dec 2018 who were diagnosed with CHD were identified from local neonatal database. Cases with confirmed post-natal echocardiogram CHD were included and cases identified antenatally were excluded. Isolated cases of ASD and VSD were also excluded from analysis.

Results

48 babies with CHD were identified. 30 were missed on antenatal screening. Of them, 17 had major CHD needing surgical intervention. Out of 17, 11 had major cyanotic heart disease and 6 had major acyanotic heart disease.

Conclusion

Up to 35% of major congenital heart diseases were still missed on foetal anomaly scans in UK. This highlights importance of implementing newborn pulse oximetry screening in conjunction with Foetal Cardiac Screening Protocol to improve detection of major CHD.

References:

NHS Fetal Anomaly Screening Programme - Congenital Heart Disease. Version 2. Apr 2013.

Background

The incidence of PDA in<28weeks babies is 75%

Objectives

To review the medical management of PDA in extreme preterm babies born at early gestation of viability at 23 weeks in a tertiary Neonatal unit in UK.

Methods

All babies born at 23+0 to 23+6 weeks were included during the study period(Jan 2010- Dec 2014).Data was collected about PDA diagnosis and management from the medical notes and local neonatal database.Significant PDA was defined as on Echo: Duct size >1.5mm,left heart dilatation La:Ao (Left atrium:Aortic) ratio: >1.4,Pulsatile ductal flow pattern,Velocity max>2mm/s,diastolic retrograde flow in descending aorta. Ibuprofen was only drug used for medical management of PDA.

Results

21 babies born during the study period were reviewed,4 babies died before ECHO at age<24 hours,constituting 17 babies in the study. Mean PDA detection was at 5.5 days.Average PDA size was 2 mm(+/- 0.78 SD), significant duct size was measured in 82 % (14/17). Average LA-Ao ratio was 1.4(0.30 SD) and significant in 47%.10 babies required Ibuprofen treatment and 7 did not require and the mean age was 5.8 days for administering it.8 babies required 1 course (Dose 10, 5, 5 mg) and 2 babies required 2 courses,1 of which required surgical ligation.Treatment associated effects of altered renal functions and NEC in 1 baby each and thrombocytopenia in 2 babies.Other co-morbidities noted were IVH(9), CLD(11),NEC-confirmed(3).6/17 babies survived to discharge.

Conclusion

Medical management of PDA even from a single NICU is quite variable.The unit will be participating in a multicenter RCT to answer some of these uncertainties.

Background

Major Congenital Heart Disease (CHD) occurs in about 35/10,000 births.Despite advances in screening programme,up to 50% of major congenital heart diseases were still missed on fetal anomaly scans in UK.

Objectives

To identify missed cases of major congenital heart disease¹ which require immediate cardiac assessment and/or treatment within the first two weeks of a child’s life.

Methods

Babies born from 1^st January 2014- 31^st Dec 2018 who were diagnosed with CHD were identified from local neonatal database. Cases with confirmed post-natal echocardiogram CHD were included and cases identified antenatally were excluded. Isolated cases of ASD and VSD were also excluded from analysis.

Results

48 babies with CHD were identified. 30 were missed on antenatal screening. Of them, 17 had major CHD needing surgical intervention. Out of 17, 11 had major cyanotic heart disease and 6 had major acyanotic heart disease.

Conclusion

Up to 35% of major congenital heart diseases were still missed on foetal anomaly scans in UK. This highlights importance of implementing newborn pulse oximetry screening in conjunction with Foetal Cardiac Screening Protocol to improve detection of major CHD.

References:

NHS Fetal Anomaly Screening Programme - Congenital Heart Disease. Version 2. Apr 2013.