1. Fetal cardiology service evaluation Antenatal diagnosis rate 2017
Dr R Newbegin ST7 Paediatrics
Dr J Murphy ST7 Paediatrics
Dr E Brown Consultant

2. NICOR – National Institute for Cardiovascular Outcomes Research
Antenatal Diagnosis Evidence suggests that antenatal diagnosis of major congenital heart disease improves outcomes, particularly from the point of view of serious morbidity such as brain damage. For the purposes of comparative audit of antenatal diagnosis we have chosen to analyse data only for babies who require surgery or therapeutic catheterisation during the first year of life, excluding those with patent ductus, patent foramen ovale or atrial septal defect, as these conditions are not diagnosed antenatally. The NICOR Congenital dataset contains only one simple piece of information concerning antenatal diagnosis – whether the heart abnormality was detected antenatally or not.
We present data on the percentage of patients being treated by surgery or intervention in the first year of their life, in each cardiac centre, in cases with this data field properly completed. The value shown is the percentage of eligible cases that were successfully diagnosed antenatally.
Please note this is not the same as the overall antenatal detection rate as it does not take into account deaths during pregnancy or peri-natal deaths or where the condition is less severe and does not require treatment in the first 12 months or where a decision is made not to intervene due to the complexity of the heart abnormality or associated comorbidities.
Results are averaged over a 5 year period and also shown for the most recent full year available.

3. NICOR – Antenatal detection rates 2013-2016
endocument

4. Leeds data 2017

5. Antenatal diagnosis rate 2017
Total number of children < 1 year who had surgery or intervention in (excluding PDA)
173
Data analysed for 172
1 exclusion (one born in Kuwait)
Antenatally diagnosed 91
Not antenatally diagnosed 81
Antenatal diagnosis rate 52.9%

6. Demographics ETHNICITY Postnatal Antenatal Caucasian 63 64 Black 213 16
Other 8
Unknown 1
Demographics
GENDER
Postnatal
Antenatal
Female 32 37
Male 49 54

7. Red – Postnatal diagnosis Blue – Antenatal diagnosis
Harrogate baby born in Kuwait (ignore)
Red – Postnatal diagnosis
Blue – Antenatal diagnosis

8. Antenatal and postnatal diagnoses

9. Antenatal and postnatal diagnoses

10. Antenatal and postnatal diagnoses

11. Antenatal and postnatal diagnoses
2 missed TGA
Both presented as cyanosed neonate. Neither had a fetal scan. One from Barnsley, one from Leeds

12. Antenatal and postnatal diagnoses

13. Missed diagnosis by area

14. Manchester – missed diagnosis
Tetralogy of Fallot

15. East Yorkshire – missed diagnoses
VSD
VSD, ASD, CoA
Supracardiac TAPVD
Lesions which are easily missed antenatally

16. Lincoln – missed diagnoses
MR, TR, PPHN (had mitral valve replacement)
Tetralogy of Fallot *
Double aortic arch, vascular ring*
Aortic arch hypoplasia, coarctation, multiple VSDs*
Coarctation, bicuspid aortic valve *

17. Lincoln – missed diagnoses
MR, TR, PPHN (had mitral valve replacement)
Tetralogy of Fallot *
Double aortic arch, vascular ring*
Aortic arch hypoplasia, coarctation, multiple VSDs*
Coarctation, bicuspid aortic valve *
*3 vessel view

18. Summary Antenatal detection rate amongst the highest in the UK
✅ Good at detecting TGA and single ventricles
(4 AVSD and 2 TGA were missed)
❌ Majority of ‘missed’ cases were either VSD or TOF
Most common anomalies
Easy to miss on scan

19. Limitations NICOR allows for national data comparisons. However…
Data does not account for those who die prior to any intervention
Data does not account for those who have a termination following an antenatal diagnosis

20. Another thought…
Have there been any cases who were not antenatally diagnosed, but did have a fetal echo?
None found in our audit group

21. Subsequent action taken….
Further training provided ✅
Boston
Grantham
Lincoln
Continually reviewing any postnatal diagnoses where a fetal echo had been performed
In progress
Audit of outcomes for those diagnosed antenatally including termination rates
Re-audit using 2018 data
Watch this space…….!
Use our data to look at training in areas where antenatal diagnoses are being missed
Target geographical areas
Target teaching to detect specific lesions