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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Consultant Niels Vejlstrup, Rigshospitalet, Denmark
- Second opponent: Professor Ragnhild Støen, NTNU: Norwegian University of Science and Technology, Norway
- Third member and chair of the evaluation committee: Associate Professor Helge Skulstad, University of Oslo
Chair of the Defence
Professor Emeritus Guttorm Haugen, University of Oslo
Principal Supervisor
Professor II Henrik Holmstrøm, University of Oslo
Summary
Congenital heart defects (CHDs) are the most common congenital defects and affect approximately one percent of newborns. Despite screening programs, enhanced diagnostics and improved treatment and outcome, CHDs are still a main reason for early morbidity and mortality.
This study investigated early mortality in children born between 2004 and 2016 with severe CHDs in Norway. Secondly, we examined changes over time in pre-and postnatal detection of severe CHDs (2004-2005 compared with 2017-2020).
The study was a nationwide, retrospective registry study. National registries were used to identify the cases and medical records to extract detailed clinical information.
The mortality before two years of age in children with severe CHDs was 10% (236/2359), which is lower than previously reported. Of these 236 children, 46% died in palliative care, 11% unexpectedly before planned cardiac intervention, 26% unexpectedly per-/postoperative in the hospital, and 17% unexpectedly following discharge after cardiac intervention. There were no changes during the study period. Most children (90%) who died unexpectedly outside of surgery had a combination of risk factors for adverse outcomes. Most deaths following discharge after cardiac intervention occurred after a gradual deterioration and in relation to an intercurrent infection. These children should be followed up closely, particularly in case of an infection.
The prenatal detection increased from 30% in 2004-2005 to 64% in 2017-2020, whereas the postnatal pre-discharge detection did not change. In 2017-2020, most children with severe CHDs (87%, 386/442) were diagnosed either prenatally or before discharge after birth. Circulatory collapse due to an undetected CHD was rare (1.6%, 7/442).
Screening concerns the use of health care resources and in this study, approximately 7000 routine examinations were performed after birth to detect one case of severe CHD. The cost-effectiveness of postnatal screening should be further evaluated.
Additional information
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