091 Does antenatal diagnosis influence outcome in vein of galen malformation?. (December 2018)

• Record Type: Journal Article
• Authors: Sturgess, E; Randle, E
• Is Part Of: Archives of disease in childhood. Volume 103:Supplement 2(2018)
• Page Start: A37
• Page End: A37
• Publication Date: 2018-12
• Subjects: Infants -- Diseases -- Periodicals; Newborn infants -- Diseases -- Periodicals; Fetus -- Diseases -- Periodicals; 618.920105
• DOI: 10.1136/goshabs.91
• Languages: English
• ISSNs: 1359-2998

Abstract

Abstract : Introduction: Vein of Galen anomalous malformation (VGAM) is a rare congenital vascular malformation. The Children's Acute Transports Service (CATS) transport neonates with VGAM into the national treatment centre. Antenatal diagnosis may be suggestive of a larger malformation however it permits prompt intervention and may reduce the incidence of high output cardiac failure. Aim: To investigate any difference in survival rates for neonates diagnosed antenatally (AN) or postnatally (PN) with VGAM. Methods: Case note review from March 2009 to July 2015 (76 months). All VGAM cases in the neonatal period requiring the first admission to the neurovascular centre. Results: 38 cases were identified, 12 AN and 26 PN diagnosis. Median age at referral differed between groups (AN 0.5 days, PN 2.5 days). The PN group predominantly presented with heart failure (10, 38%) or cardiomegaly (7, 27%). AN diagnosed neonates were more likely to be transported intubated (42% vs 31%) and less likely to require inotropes (33% vs 54%). 42% PN children were transferred twice before admission to the neurovascular centre. Overall, survival was 15/36, 42% (AN, 50% PN, 37%). Those requiring inotropes at transfer demonstrated 28% survival; those without an inotrope requirement had a 56% survival. These survival rates are summarised in figure 1. Conclusions: Antenatal diagnosis of VGAM appears to increase the chance of survival with a decreased incidence of high output cardiac failure. Neonates not requiring inotropic support during transfer are twice as likely to survive than those who do. The small sample size is acknowledged, however, we believe this is the largest recent case series of neonates with VGAM requiring their first admission to the UK national neurovascular centre.