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A study of congenital cardiac disease in a neonatal population – the validity of echocardiography undertaken by a neonatologist

Published online by Cambridge University Press:  21 January 2005

Gregory R. Samson  and
Suresh R. Kumar
Gregory R. Samson
Affiliation:
Department of Neonatal Medicine, Al Corniche Hospital, Abu Dhabi, United Arab Emirates
Suresh R. Kumar
Affiliation:
Department of Cardiology, Al Mafraq Hospital, Abu Dhabi, United Arab Emirates
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Abstract

Objectives: To estimate the incidence of, and profile the spread of, congenital cardiac defects, and to assess the accuracy of the echocardiographic diagnosis as performed by a neonatologist. Design: Hospital-based study. Methods: All neonates meeting our criterions, specifically those with a persistent murmur 48 hours after birth, underwent an echocardiographic examination to exclude an underlying congenital cardiac defect. All scans performed by the neonatologist were videotaped and reviewed by a paediatric cardiologist. We assessed concordance according to inter-rater agreement. Results: Out of 11,085 live births, there were 83 infants with a congenital cardiac defect, giving an incidence of 7.49 per 1000 live births, with 95% confidence interval from 5.88 to 9.09. Of the infants with a murmur persisting at or greater than 48 hours after birth, who had a median age of 4.5 days, 75% had a congenital heart defect, with ventricular septal defect being the commonest, encountered in 56.7% of cases. Concordance between the neonatologist and the cardiologist was good, with Cohen's Kappa coefficient being calculated at 0.68, and 95% confidence interval from 0.51 to 0.85. Conclusion: The incidence of congenital cardiac malformations as determined in our hospital-based study in the United Arab Emirates is similar to that described in the Gulf region and worldwide. A persistent murmur at or greater than 48 hours after birth is strongly suggestive of an underlying congenital cardiac malformation. Our experience shows that a neonatologist appropriately trained in echocardiography can perform as well as a paediatric cardiologist. Where specialist resources are limited, this allows for early diagnosis, earlier referral if necessary, and early institution of appropriate therapy.

Keywords

Congenital heart diseaseepidemiologynon-invasive investigation
Type
Original Article
Information
Cardiology in the Young , Volume 14 , Issue 6 , December 2004 , pp. 585 - 593
Copyright
© 2004 Cambridge University Press

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References

Khalil A, Aggarwal R, Thirupuram S, Arora R. Incidence of congenital heart disease among hospital live births in India. Indian Pediatr 1994; 31: 519–527.Google Scholar
Wren C, Richmond S, Donaldson L. Presentation of congenital heart disease in infancy: implications for routine examination. Arch Dis Child Fetal Neonatal Ed 1999; 80: F44–F53.Google Scholar
Fixler DE, Pastor P, Chamberlin M, Sigman E, Eifler CW. Trends in congenital heart disease in Dallas county births 1971–1984. Circulation 1990; 81: 137–142.Google Scholar
Subramanyan R, Joy J, Venugopalan P, Sapru A, Al Khusaiby SM. Incidence and spectrum of congenital heart disease in Oman. Ann Trop Pediatr 2000; 20: 337–341.Google Scholar
Bower C, Ramsay JM. Congenital heart disease: a 10 year cohort. J Pediatr Child Health 1994; 30: 414–418.Google Scholar
Alabdulgader AAA. Congenital heart disease in 740 subjects: epidemiological aspects. Ann Trop Pediatr 2001; 21: 111–118.Google Scholar
Robida A, Folger GM, Hajar HA. Incidence of congenital heart disease in Qatari children. Int J Cardiol 1997; 60: 19–22.Google Scholar
Evans N. Echocardiography on neonatal intensive care units in Australia and New Zealand. J Paediatr Child Health 2000; 36: 169–171.Google Scholar
Skinner J, Alverson D, Hunter S (eds). Echocardiography for the Neonatologist. Churchill Livingstone, London, 2000.
Altman DG. Practical Statistics for Medical Research. Chapman and Hall, London, 1991.
Hoffman JIE. Incidence of congenital heart disease: I. Postnatal Incidence. Pediatr Cardiol 1995; 16: 103–113.Google Scholar
Freeman SB, Taft LF, Dooley KJ, et al. Population-based study of congenital heart disease in Down syndrome. Am J Med Gen 1998; 80: 213–217.Google Scholar
Tubman TR, Shields MD, Craig BG, Mulholland HC, Nevin NC. Congenital heart disease in Down's syndrome: two year prospective early screening study. BMJ 1991; 302: 1425–1427.Google Scholar
Bhatia S, Verma IC, Shrivastava S. Congenital heart disease in Down Syndrome: an echocardiographic study. Indian Pediatr 1992; 29: 1113–1115.Google Scholar
Jones KL. Smith's Recognizable Patterns of Human Malformation, 5th edn. WB Saunders Co., 1997.
Al-Jawad ST, Shubbar AI, Khafaji NA, Kholeif SA, Lane SM, Moore DK. A survey of serious congenital morphological abnormalities in Abu Dhabi. Ann Trop Pediatr 1988; 8: 76–79.Google Scholar
Niazi MA, Al-Mazyad AS, Al-Husain MA, et al. Down's syndrome in Saudi Arabia: incidence and cytogenetics. Hum Hered 1995; 45: 65–69.Google Scholar
Verma IC, Mathews AR, Faquth A, el-Zouki AA, Malik GR, Mohammed F. Cytogenetic analysis of Down syndrome in Libya. Indian J Pediatr 1990; 57: 245–248.Google Scholar
Stoll C, Alembik Y, Dott B, Roth MP. Epidemiology of Down syndrome in 118,265 consecutive births. Am J Med Gen 1990; 7: 79–83.Google Scholar
Wells GL, Barker SE, Finley SC, Colvin EV, Finley WH. Congenital heart disease in infants with Down's syndrome. South Med J 1994; 87: 724–727.Google Scholar
Torfs CP, Christianson RE. Maternal risk factors and major associated defects in infants with Down syndrome. Epidemiology 1999; 10: 264–270.Google Scholar
Venugopalan P, Agarwal AK. Spectrum of congenital heart defects associated with Down syndrome in high consanguineous Omani population. Indian Pediatr 2003; 40: 398–403.Google Scholar
Lin MH, Wang NK, Hung KL, Shen CT. Spontaneous closure of ventricular septal defects in the first year of life. J Formos Med Assoc 2001; 100: 539–542.Google Scholar
McMahon CJ, Feltes TF, Fraley JK, et al. Natural history of growth of secundum atrial septal defects and implications for transcatheter closure. Heart 2002: 87; 256–259.Google Scholar
Mironiuk M, Kietlinska Z, Jezierska-Kasprzyk K, Piekosz-Orzechowska B. A class of diabetes in mother, glycemic control in early pregnancy and occurrence of congenital malformations in newborn infants. Clin Exp Obstet Gynecol 1997; 24: 193–197.Google Scholar
Janssen PA, Rothman I, Schwartz SM. Congenital malformations in newborns of woman with established and gestational diabetes in Washington State, 1984–91. Paediatr Perinat Epidemiol 1996; 10: 52–63.Google Scholar
Loffredo CA, Wilson PD, Ferencz C. Maternal diabetes: an independent risk factor for major cardiovascular malformations with increased mortality of affected infants. Teratology 2001; 64: 98–106.Google Scholar
Becerra JE, Khoury MJ, Cordero JF, Erickson JD. Diabetes mellitus during pregnancy and the risks for specific birth defects: a population-based case–control study. Pediatrics 1990; 85: 1–9.Google Scholar
Wren C, Birrell G, Hawthorne G. Cardiovascular malformations in infants of diabetic mothers. Heart 2003; 89: 1217–1220.Google Scholar
Ferencz C, Rubin JD, McCarter RJ, Clark EB. Maternal diabetes and cardiovascular malformations: predominance of double outlet right ventricle and truncus arteriosus. Teratology 1990; 41: 319–326.Google Scholar
Southall DP, Johnson AM, Shinebourn EA, Johnston PG, Vulliamy DG. Frequency and outcome of disorders of cardiac rhythm and conduction in a population of newborn infants. Pediatrics 1981; 68: 58–66.Google Scholar
Calvin SE, Gaziona EP, Bendel RP, Knox GE, Brandt DG. Evaluation of fetal cardiac arrythmias. Ultrasound findings and neonatal outcome. Minn Med 1992; 75: 29–31.Google Scholar
Eronin M, Siren MK, Ekblad H, Tikanoja T, Julkunen H, Paavilainen T. Short- and long-term outcome of children with congenital complete heart block diagnosed in utero or as a newborn. Pediatrics 2000; 106: 86–91.Google Scholar
Tanel RE, Rhodes LA. Fetal and neonatal arrhythmias. Clin Perinatol 2001; 28: 187–207.Google Scholar
Rein AJJT, Omokhodion SI, Nir A. Significance of a cardiac murmur as the sole clinical sign in the newborn. Clin Pediatr 2000; 39: 511–520.Google Scholar
Farrer KFM, Rennie JM. Neonatal murmurs: are senior house officers good enough? Arch Dis Child Fetal Neonatal Ed 2003; 88: F147–F151.Google Scholar
Du Z-D, Roguin N, Barak M. Clinical and echocardiographic evaluation of neonates with heart murmurs. Acta Paediatr 1997; 86: 752–756.Google Scholar
Ward CJB, Purdie J. Diagnostic accuracy of paediatric echocardiograms interpreted by individuals other than paediatric cardiologists. J Paediatr Child Health 2001; 37: 331–336.Google Scholar
Scholler G. Echocardiography in congenital heart disease: Diagnosis, misdiagnosis and ownership. J Paediatr Child Health 2001; 37: 321–322.Google Scholar
Skinner JR. Echocardiography on the neonatal unit. A job for the neonatologist or the cardiologist. Arch Dis Child 1998; 78: 401–402.Google Scholar
Evans N. Echocardiography on neonatal intensive care units in Australia and New Zealand. J Paediatr Child Health 2000; 36: 169–171.Google Scholar
Moss S, Kitchener DJ, Yoxall CW, Subhedar NV. Evaluation of echocardiography on the neonatal unit. Arch Dis Child Fetal Neonatal Ed 2003; 88: F287–F291.Google Scholar
Whitehall J. Echocardiography by a neonatologist (Letter). Arch Dis Child 1999; 80: 579.Google Scholar
Arlettaz R, Archer N, Wilkinson AR. Natural history of innocent murmurs in newborn babies: controlled echocardiographic study. Arch Dis Child Fetal Neonatal Ed 1998; 78: F166–F170.Google Scholar
Fisher DC, Fisher EA, Budd JH, Rosen ES, Goldman ME. The incidence of patent foramen ovale in 1000 consecutive patients. Chest 1995; 107: 1504–1509.Google Scholar
Evans N. Assessment of interatrial shunting. In: Skinner J, Alverson D, Hunter S (eds). Echocardiography for the Neonatologist. Churchill Livingstone, London, 2000.