Objective: Analysis of the clinical presentation and management of CHD in neonates to guide improvements in transport stabilization.
Methods: A retrospective review of neonates transported with a post-admission diagnosis of CHD during April 2005 to June 2006.
Results: 62 neonates with CHD (7.5% of all transports) presented to regional transport in our region. Mean BW was 3305+/-703g, GA 38.7+/-1.8 weeks, and median age of presentation was 0 (IQR 0, 1) days. Acyanotic CHD accounted for 61%, including TGA 19, PA/IVS/VSD 5, TOF 4, PS 4,TAPVD 3, Ebsteins 2, truncus 1; 39% were acyanotic (coarctation 9, HLHS 7, interrupted aortic arch 3, AVSD 2, AS 1, cardiomyopathy 1). Most common presenting symptoms were cyanosis 76%, murmur 53%, respiratory distress 53% and shock 18%. Fifty (81%) had duct-dependent lesions and PGEs were started during stabilization in 90% of cyanotic and 88% of acyanotic lesions. Acyanotic lesions received more support compared with cyanotic lesions: 79% vs 47% ventilated (p=0.04); inotropes 33% vs 5% (p=0.01). Acyanotic lesions presented with lower pH and this difference in pH increased at NICU admission. Mean pH on initial presentation was: acyanotic 7.30 +/-0.14 vs cyanotic 7.33+/-0.10 (p=0.14); pH on NICU admission was: acyanotic 7.28+/-0.11 vs cyanotic 7.35+/-0.12 (p=0.03). Mean lactate on NICU admission was: acyanotic 6.9 +/-7.5 vs cyanotic: 3.2 +/-6.9 (p=0.02).
Conclusions: These data highlight the challenges transport teams face when managing undifferentiated infants with unexpected significant CHD. Acyanotic lesions were less stable on presentation, required more support during stabilization, and arrived in less stable condition.