(542) Standardized Clinical Assessment and Management Plan Improves Neonatal Outcomes in prenatally suspected Congenital Heart Disease

Thursday, January 30, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

Lior Kashani Ligumsky, MD

Research Fellow
University of California, Los Angeles
Los Angeles, California, United States

Coauthor(s)

AD

Angela Desmond, MD

University of California, Los Angeles
Los Angeles, California, United States
GM

Guadalupe Martinez, BS

University of California, Los Angeles
Los Angeles, California, United States
JN

Joanne Newens

University of California, Los Angeles
Los Angeles, California, United States
Deborah Krakow, MD

Professor and Chair
University of California, Los Angeles
Los Angeles, California, United States
GS

Gary Satou, MD

University of California, Los Angeles
Los Angeles, California, United States
Yalda Afshar, MD, PhD (she/her/hers)

University of California, Los Angeles
Los Angeles, California, United States

Objective: Prenatal diagnosis of congenital heart disease (CHD) has been associated with early-term and cesarean births. We implemented a standardized clinical assessment and management plan (SCAMP) aimed at reducing early-term and cesarean births. We aimed to evaluate the SCAMP’s impact on neonatal outcomes focusing on survival at discharge rate and birthweight in pregnancies complicated by fetal CHD.

Study Design: Neonatal data from historical and intervention cohorts before and after SCAMP implementation were analyzed. Neonates with complete data on birth mode, birthweight, and survival at discharge were included. The primary outcome was survival at discharge. Secondary outcomes included birthweight and survival differences based on birth mode (vaginal birth, IOL, and cesarean birth). Statistical comparisons used t-tests for continuous and chi-square tests for categorical variables.

Results: A total of 424 pregnancies were included in the study, comprising 177 historical pregnancies and 247 intervention cohort pregnancies. Mean birthweight increased from 2808g in the historical cohort to 2967g in the post-SCAMP intervention cohort (p=0.02). The overall survival rate to discharge was higher in the intervention cohort (91.1%) compared to the historical cohort (83.1%) (p=0.012). In the cesarean birth group, survival rates were higher in the intervention cohort (89.1%) compared to the historical cohort (76.1%) (p=0.02). There were no significant differences in survival rates for induction of labor and spontaneous births between the historical and intervention cohorts (p=0.8 and p=0.1, respectively).

Conclusion: The implementation of a SCAMP focused on reducing early-term and cesarean birth significantly improved neonatal outcomes, notably increasing neonates with CHD survival rates at discharge. This improvement was most pronounced in cesarean births. Clinical pathways focused on the prenatal course of pregnancies affected by CHD improve neonatal outcomes.