Neonatal echocardiogram in duodenal obstruction is unnecessary after normal fetal cardiac imaging
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In brief
In brief
This retrospective study of 65 infants with duodenal obstruction demonstrates that neonatal echocardiography adds no diagnostic value when prenatal cardiac imaging is normal (NPV 100%). The authors recommend against routine postnatal echocardiograms in this population to avoid unnecessary delays in surgical repair.
Written by the GCMD Library team from the article.
Background
Duodenal obstruction (DO) is associated with congenital cardiac anomalies that may complicate the delivery of anesthesia during surgical repair. As most infants undergo fetal ultrasounds that identify cardiac anomalies, our aim was to determine the utility of obtaining preoperative neonatal echocardiograms in all DO patients.
Methods
We conducted a retrospective cohort study of all DO patients treated at two tertiary care children's hospitals between January 2005 and February 2016. Prenatal ultrasounds were compared to neonatal echocardiograms to determine concordance. Binomial exact analyses were used to estimate the negative predictive value (NPV) of prenatal imaging.
Results
We identified 65 infants with DO. The majority of patients (93.8%) had prenatal ultrasounds, including twenty patients that underwent fetal echocardiogram. Fourteen (21.5%) were diagnosed with cardiac lesions in utero, and neonatal echocardiograms confirmed 12 lesions, without identifying any new lesions. No changes to anesthetic management were made because of cardiac lesions. The NPV of prenatal imaging was 100% (95% Confidence Interval: 91.0–100.0).
Conclusions
Neonatal echocardiogram is unlikely to identify new cardiac lesions in DO patients with negative fetal imaging and delays in surgical care are unwarranted.
Levels of evidence
Study of Diagnostic Test-Level II.