To Improve The Surgical Results Of Neonatal Critical Congenital Heart Diseases

Background and subjectiveChildren with critical congenital heart disease(CCHD)could be in critical status early after birth,if not intervened,the natural mortality would be very high.With the improvement of surgical techniques for congenital heart disease,the treatment for congenital heart disease at young age and low weight had become an important direction in the development of cardiac surgery.Besides,most of the cardiac birth defects could be diagnosed before delivery with the rapid development of fetal echocardiography and other prenatal diagnostic technologies.However,the diagnosis and treatment level varied in different medical units in China due to the relative lack of understanding of congenital heart diseases,especially complex congenital heart diseases,among obstetricians?neonatologists and sonographers.Hence,it was of great significance to provide scientific consultation and guidance to patients' families and to carry out appropriate and very effective perinatal transfer mechanisms and also multidisciplinary clinical cooperation.In this context,a multidisciplinary joint treatment platform about " prenatal diagnosis and postnatal treatment integration " had been established for fetuses and newborns with critical congenital heart disease with the help of obstetricians?neonatologists and sonographers.The platform consisted of prenatal diagnosis and postnatal treatment integration model and postnatal diagnosis and rapid admission by green channel model,had obtained very satisfactory results.By summarizing the treatment experience of 120 neonates from January 2019 to December 2020,the study aimed to construct a new treatment system for children with critical congenital heart disease that cooperate with national conditions,to provide the optimal treatment plan at the best time,and to improve the diagnosis and treatment level of critical congenital heart disease in China.Methods and ResultsThis study contained three parts.The first part introduced the experience of'prenatal diagnosis and postnatal treatment integration model' for CCHD,mainly established by pediatric cardiac center with multiple disciplines such as obstetricians?neonatologists and sonographers from several hospitals.The model consisted of intrauterine diagnosis,prenatal consultation,perinatal management,emergent transportation after birth and effective long-term follow-up after surgical intervention.A total of 47 fetuses with CCHD received effective treatment with no early death during neonatal period,reaching international advanced level.Secondly,we retrospectively reviewed the clinical data of neonates with CCHD who admitted to pediatric cardiac center from January 2019 to December 2020 at our hospital,and divided the patients into prenatal diagnosis and postnatal treatment integration group,and postnatal diagnosis and rapid admission by green channel group.Summarizing the characteristics and surgical results of the two neonatal treatment models,it would be clear to understand that 'prenatal diagnosis and postnatal treatment integration model'had many advantages,including shorting the diagnosis and the hospitalization interval of the newborns,performing surgical intervention timely and reducing the risk of death before surgery.Patients with postnatal diagnosis and admitted into hospital through green channel could also get perfect results if surgical intervention was performed timely.'Prenatal diagnosis and postnatal treatment integration model' was a hot topic in the field of neonatal congenital heart disease in China.The third part was a review aimed to analyze the effects of prenatal echocardiograph on critical congenital heart diseases,intrauterine intervention therapy,surgical treatment for neonatal congenital heart disease,and to explore the future development direction of neonatal critical congenital heart disease in China.Overall,with the popularization of prenatal diagnosis technology in China,to build a high level'prenatal diagnosis and postnatal treatment integration' platform and to improve the level of 'homogenization' of diagnosis and treatment services at different regions were the key tasks to further improve the treatment capacity of congenital heart disease in the future.ConclusionsThe 'prenatal diagnosis and postnatal treatment integration platform',which consisted of'prenatal diagnosis and postnatal treatment integration model' and 'postnatal diagnosis and rapid admission by green channel model',had a significant effect on the treatment for critical congenital heart diseases.And the former model had the advantages of improving the success rate of treatment.The platform should be further promoted to improve the treatment level of critical congenital heart disease in China.