176 - Variations in Practice in Fetal and Neonatal Congenital Heart Disease within the Children’s Hospitals Neonatal Consortium

Poster Number: 176
Publication Number: 176.101

Rachel L. Leon, University of Texas Southwestern Medical School, Dallas, TX, United States; Sushmita G. Yallapragada, University of Texas Southwestern Medical School, DALLAS, TX, United States; June Hu, UT Southwestern School of Medicine, Dallas, TX, United States; Philip T. Levy, Harvard Medical School, Boston, MA, United States; Shannon E. Hamrick, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States; Molly K. Ball, Nationwide Children's Hospital, Columbus, OH, United States

Background: Congenital heart disease (CHD) is the most common birth defect and requires complex multidisciplinary care from prenatal diagnosis to adulthood. Many aspects of prenatal and neonatal CHD care fall outside of standard practice guidelines leading to the potential for significant variation in practice.

Objective: To determine the variation in practice for specific aspects of prenatal and neonatal CHD care across member hospitals of the Children’s Hospitals Neonatal Consortium (CHNC).

Design/Methods: A cross-sectional, 25-question survey was administered to site sponsors within the CHNC network to assess participation of neonatologists in prenatal counseling, fetal interventions offered, prenatal imaging, typical timing and mode of delivery, placental pathologic examination, genetic testing practices, use of near-infrared spectroscopy (NIRS) in both cardiac and neonatal intensive care units (CICU, NICU respectively), post-operative electroencephalography (EEG), and neurodevelopmental follow-up.

Results: A total of 31 centers out of 41 member hospitals provided responses (76% response rate). Median number of fetal consults annually at the centers surveyed is 50 (IQR 20, 80). Fetal care services are most often shared by neonatology and pediatric cardiology, but in one-fourth of centers only cardiologists routinely provide prenatal counseling. Psychologists are incorporated into the fetal care program in 33% of centers. Only 3 (10%) centers routinely use MRI for fetuses diagnosed with CHD. Regarding delivery practices, 10 (35%) centers routinely allow spontaneous labor while an additional 4 (14%) centers base delivery mode and timing on anticipated urgency of neonatal intervention. Routine pathologic examination of the placenta is performed at half of centers (56%) surveyed while genetic testing is routinely offered to all patients with CHD in three-fourths (76%) of centers. Regarding neuromonitoring, pre-operative brain MRI is routine practice at 5 (17%) centers, NIRS is routinely used across hospital units in 14 (48%) centers but only used in the CICU (not NICU) at 10 (35%) centers, and post-operative EEG is routine in 5 (17%) centers surveyed. Neurodevelopmental follow-up programs are offered at all but one center, however there is significant variability in whether those programs are operated within pediatric cardiology, neonatology, complex care, or a mixture of these divisions.Conclusion(s): A lack of well-accepted, evidence-based guidelines for fetal and neonatal CHD care has led to significant variability in clinical practice among major pediatric hospitals within the CHNC.
Table 1. Frequency of Select Clinical PracticesMRI: magnetic resonance imaging, NIRS: near-infrared spectroscopy, EEG: electroencephalogram