{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T22:15:12Z","timestamp":1793830512590,"version":"4.6.1"},"reference-count":22,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:p>\n            Objective\u2003Risk stratification of fetuses diagnosed with congenital heart disease (CHD) helps provide a delivery plan and prepare families and medical teams on expected course in the delivery room. Our aim was to assess the accuracy of echocardiographically determined risk-stratification assignments in predicting postnatal cardiac outcomes beyond the delivery room.<\/jats:p><jats:p>\n            Study Design\u2003This was a retrospective study at a single center evaluating all fetuses with CHD who were risk-stratified by echocardiographically determined level of care (LOC) assignment, ranging from 1a (lowest risk) to 4 (highest risk). All data were collected from January 1, 2017, to November 1, 2021. Outcomes included any unexpected cardiac interventions and neonatal clinical outcomes including in-hospital mortality, the need for prostaglandins or inotropes, and defined critical illness. These outcomes were assessed for each LOC assignment by Fisher's exact test.<\/jats:p><jats:p>\n            Results\u2003Out of 817 patients assigned a LOC, a total of 747 fetuses were included in our final cohort with a separate subanalysis of 70 fetuses diagnosed with coarctation of the aorta. The sensitivity and specificity were high for all LOC levels in predicting delivery room needs (93\u2013100%). Higher LOC levels (3\u20134) had a lower positive predictive value (66\u201367%) indicating a high false-positive rate. Subjects with higher LOC assignments had a greater frequency of critical illness, hospital mortality, need for inotropes, need for neonatal surgical or catheterization interventions, and need for prostaglandins (p\u2009&lt;\u20090.001 for all outcomes). A post-hoc analysis reviewing LOC assignments revealed a greater tendency to over-assign LOC at higher assignments (19% for LOC 3 and 4) compared to lower assignments (4% for LOC 1 and 2).<\/jats:p><jats:p>\n            Conclusion\u2003Risk stratification based on fetal echocardiography can predict neonatal clinical outcomes and acuity of postnatal management needs. However, there is greater variability in expected clinical events and an expected degree of false positives for those with higher LOC assignments.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/s-0044-1788718","type":"journal-article","created":{"date-parts":[[2024,7,29]],"date-time":"2024-07-29T23:43:30Z","timestamp":1722296610000},"page":"369-378","source":"Crossref","is-referenced-by-count":5,"title":["Utilizing Fetal Echocardiography to Risk Stratify and Predict Neonatal Outcomes in Fetuses Diagnosed with Congenital Heart Disease"],"prefix":"10.1055","volume":"42","author":[{"given":"Sanghee S.","family":"Ro","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Milligan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joe","family":"Kreeger","sequence":"additional","affiliation":[{"name":"Children's Healthcare of Atlanta Cardiology, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle E.","family":"Gleason","sequence":"additional","affiliation":[{"name":"Children's Healthcare of Atlanta Cardiology, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Porter","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Border","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Eric","family":"Ferguson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritu","family":"Sachdeva","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Michelfelder","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,7,29]]},"reference":[{"issue":"11","key":"ref1","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1016\/j.echo.2015.07.005","article-title":"Risk-stratified postnatal care of newborns with congenital heart disease determined by fetal echocardiography","volume":"28","author":"M T Donofrio","year":"2015","journal-title":"J Am Soc Echocardiogr"},{"issue":"07","key":"ref2","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1002\/pd.2260","article-title":"Utility of fetal echocardiography in postnatal management of infants with prenatally diagnosed congenital heart disease","volume":"29","author":"E M Berkley","year":"2009","journal-title":"Prenat Diagn"},{"issue":"05","key":"ref3","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/j.amjcard.2012.11.029","article-title":"Specialized delivery room planning for fetuses with critical congenital heart disease","volume":"111","author":"M T Donofrio","year":"2013","journal-title":"Am J Cardiol"},{"issue":"21","key":"ref4","doi-asserted-by":"crossref","first-page":"2183","DOI":"10.1161\/01.cir.0000437597.44550.5d","article-title":"Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association","volume":"129","author":"M T Donofrio","year":"2014","journal-title":"Circulation"},{"issue":"09","key":"ref5","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1161\/01.CIR.103.9.1269","article-title":"Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome","volume":"103","author":"W Tworetzky","year":"2001","journal-title":"Circulation"},{"issue":"07","key":"ref6","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1161\/01.CIR.99.7.916","article-title":"Detection of transposition of the great arteries in fetuses reduces neonatal morbidity and mortality","volume":"99","author":"D Bonnet","year":"1999","journal-title":"Circulation"},{"issue":"05","key":"ref7","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1046\/j.1469-0705.2001.00398.x","article-title":"Comparative analysis of pattern, management and outcome of pre- versus postnatally diagnosed major congenital heart disease: a population-based study","volume":"17","author":"E T Jaeggi","year":"2001","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"07","key":"ref8","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1016\/j.echo.2004.04.011","article-title":"American Society of Echocardiography guidelines and standards for performance of the fetal echocardiogram","volume":"17","author":"J Rychik","year":"2004","journal-title":"J Am Soc Echocardiogr"},{"issue":"06","key":"ref9","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.7863\/jum.2013.32.6.1067","article-title":"AIUM practice guideline for the performance of fetal echocardiography","volume":"32","author":"American Institute of Ultrasound in Medicine","year":"2013","journal-title":"J Ultrasound Med"},{"issue":"19","key":"ref10","doi-asserted-by":"crossref","first-page":"2974","DOI":"10.1161\/CIRCULATIONAHA.105.534180","article-title":"Predictive value of fetal pulmonary venous flow patterns in identifying the need for atrial septoplasty in the newborn with hypoplastic left ventricle","volume":"112","author":"E Michelfelder","year":"2005","journal-title":"Circulation"},{"issue":"04","key":"ref11","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1016\/j.jtcvs.2010.09.043","article-title":"Prediction and perinatal management of severely restrictive atrial septum in fetuses with critical left heart obstruction: clinical experience using pulmonary venous Doppler analysis","volume":"141","author":"A Divanovi\u0107","year":"2011","journal-title":"J Thorac Cardiovasc Surg"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.jpeds.2021.06.047","article-title":"A fetal risk stratification pathway for neonatal aortic coarctation reduced medical exposure","volume":"237","author":"S A Maskatia","year":"2021","journal-title":"J Pediatr"},{"issue":"10","key":"ref13","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1002\/pd.5322","article-title":"Echocardiographic predictors of neonatal illness severity in fetuses with critical left heart obstruction with intact or restrictive atrial septum","volume":"38","author":"L Gellis","year":"2018","journal-title":"Prenat Diagn"},{"issue":"06","key":"ref14","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1055\/s-0038-1637764","article-title":"Predicting the future: delivery room planning of congenital heart disease diagnosed by fetal echocardiography","volume":"35","author":"M T Donofrio","year":"2018","journal-title":"Am J Perinatol"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.ajog.2014.01.026","article-title":"Safe prevention of the primary cesarean delivery","volume":"210","author":"A B Caughey","year":"2014","journal-title":"Am J Obstet Gynecol"},{"issue":"03","key":"ref16","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1080\/14767058.2020.1725883","article-title":"Prenatal risk factors for urgent atrial septostomy at birth in fetuses with transposition of the great arteries: a systematic review and meta-analysis","volume":"35","author":"D Buca","year":"2022","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"07","key":"ref17","doi-asserted-by":"crossref","first-page":"1575","DOI":"10.1007\/s00246-021-02642-w","article-title":"Reliability of fetal echocardiography in predicting postnatal critical hypoxia in patients with transposition of great arteries and intact ventricular septum","volume":"42","author":"M Masci","year":"2021","journal-title":"Pediatr Cardiol"},{"issue":"04","key":"ref18","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/j.echo.2010.12.020","article-title":"Fetal predictors of urgent balloon atrial septostomy in neonates with complete transposition","volume":"24","author":"R Punn","year":"2011","journal-title":"J Am Soc Echocardiogr"},{"issue":"03","key":"ref19","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1007\/s00246-016-1552-y","article-title":"Timing and mode of delivery in prenatally diagnosed congenital heart disease- an analysis of practices within the University of California Fetal Consortium (UCFC)","volume":"38","author":"S Peyvandi","year":"2017","journal-title":"Pediatr Cardiol"},{"issue":"15","key":"ref20","doi-asserted-by":"crossref","first-page":"e021598","DOI":"10.1161\/JAHA.121.021598","article-title":"Multi-institutional practice-patterns in fetal congenital heart disease following implementation of a standardized clinical assessment and management plan","volume":"10","author":"Y Afshar","year":"2021","journal-title":"J Am Heart Assoc"},{"issue":"03","key":"ref21","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1002\/uog.2710","article-title":"Prenatal detection of heart defects in a non-selected population of 30,149 fetuses\u2013detection rates and outcome","volume":"27","author":"E Tegnander","year":"2006","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"02","key":"ref22","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/0735-1097(94)90429-4","article-title":"Antenatal diagnosis of coarctation of the aorta: a multicenter experience","volume":"23","author":"L K Hornberger","year":"1994","journal-title":"J Am Coll Cardiol"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0044-1788718.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T23:33:18Z","timestamp":1738711998000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0044-1788718"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,29]]},"references-count":22,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2025,2,4]]},"published-print":{"date-parts":[[2025,2]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0044-1788718","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,29]]}}}