Does prenatal diagnosis of hypoplastic left heart syndrome make a difference? – A systematic review

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Abstract

OBJECTIVE

Hypoplastic left heart syndrome is frequently diagnosed prenatally with variable benefit. We performed a systematic review to evaluate the impact of fetal diagnosis; the primary objective was to evaluate impact on mortality.

METHODS

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Seven databases were searched. Meta-analysis was performed using a random effects model to evaluate the effect of fetal diagnosis on mortality.

RESULTS

Literature search revealed 2124 titles and abstracts for screening; 21 full texts were reviewed. Six studies and one abstract were included. Preoperative mortality in 609 neonates (228 prenatal and 381 postnatal) was evaluated. There were 11 deaths in prenatally diagnosed neonates versus 16 deaths in postnatally diagnosed neonates (OR 0.67, 95% CI 0.22–2.01, p = 0.48). Neonates with fetal diagnosis had less preoperative acidosis (mean difference 0.07, 95% CI 0.05, 0.1, p < 0.01) and required less inotropic support (OR 0.16, 95% CI 0.04, 0.7, p = 0.01). Post Stage I, there were 47 deaths in 227 prenatally diagnosed neonates versus 78 deaths in 299 postnatally diagnosed neonates (OR 0.84, 95% CI 0.43, 1.62, p = 0.59).

CONCLUSIONS

There is no significant impact of prenatal diagnosis of hypoplastic left heart syndrome on preoperative or post Stage I mortality. Neonates with prenatal diagnosis were hemodynamically more stable. © 2016 John Wiley & Sons, Ltd.

Funding sources: None

Conflict of interest: None declared

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