Does antenatal diagnosis affect clinical course in neonates with simple transposition of the great arteries?

  • Dr Caroline Jones, Alder Hey Children’s Hospital, Liverpool. UK, United Kingdom
  • Dr Helen Michael, Alder Hey Children’s Hospital, Liverpool. UK, United Kingdom
  • Mr Nelson Alphonso, Alder Hey Children’s Hospital, Liverpool. UK, United Kingdom
  • Dr Gordon Gladman, Alder Hey Children’s Hospital, Liverpool. UK, United Kingdom
  • Dr Joyce Lim, Alder Hey Children’s Hospital, Liverpool. UK, United Kingdom

    • Objective
    To determine whether neonates with an antenatal (AN) diagnosis of simple transposition of the great arteries (TGA) have a different clinical course to those diagnosed in the postnatal (PN) period.

    Methods
    Retrospective analysis of notes of all neonates with simple TGA (with or without ventricular septal defect) seen in our institution between January 2001 and June 2008. Those whose anatomy was not suitable for a primary arterial switch operation (ASO) were excluded from the study.

    Results
    We identified 95 neonates with simple TGA within the given time period. Mean gestational age was 39.7 ± 1.1 weeks. Fourteen of the 95 neonates (14.7%) had an antenatal diagnosis. Three neonates in the PN group died, two prior to the ASO and one shortly following the operation. All the neonates in the AN group survived.

    Conclusions
    All neonates diagnosed with TGA antenatally were transferred promptly the cardiac centre within the first 12 hours of a life facilitating early expert management and septostomy where appropriate. All but one in this group were in good condition at presentation, not requiring ventilation. It is likely that this improved pre-operative state lead to a smoother post-operative course and slightly shorter length of stay (p=0.17). None of the patients in the antenatal group died as compared to 3 in the postnatal group. None of the patients have died in long-term follow-up (32.6 ± 26.4 months).

    AN group (14) PN group (81) P value
    Birth weight (kg) 3.6 ± 0.7 3.4 ± 0.6 NS
    Age at presentation (hours) 6.1 ± 2.3 167.5 ± 278.5 <0.0001
    Prostin dose on arrival (ng/kg/min) 13.2 ± 29 30.9 ± 37 0.0038
    Oxygen saturation on arrival (%) 82 ± 9 67 ± 15 0.0013
    Total time spent on ICU (days) 6.3 ± 3.5 9.1 ± 5.5 0.028
    Length of stay post ASO (days) 12.1 ± 4.3 14.1 ± 5.6 0.17
    Duration follow-up (months) 12.3 ±18.1 37.4 ± 26.4 0.0013