Use of fetal tele‐echo at small regional hospitals increases the rate of prenatal diagnosis of congenital heart disease. (2nd July 2022)

• Record Type: Journal Article
• Authors: Meiman, Jenna; Zhang, Charlie; Holland, Brian
• Is Part Of: Prenatal diagnosis. Volume 42:Number 9(2022)
• Page Start: 1120
• Page End: 1132
• Publication Date: 2022-07-02
• Subjects: Prenatal diagnosis -- Periodicals; Fetus -- Diseases -- Diagnosis -- Periodicals; Electronic journals; 618.32075
• DOI: 10.1002/pd.6196
• Languages: English
• ISSNs: 0197-3851

Abstract

Abstract: Background: To improve the rate of prenatal diagnosis of Congenital heart disease (CHD) in Kentucky, four fetal tele‐echocardiography sites were established at regional hospitals in Kentucky: Ashland in 2011, Paducah in 2014, Lexington in 2014, and Owensboro in 2016. Methods: A 13‐year retrospective review of medical records at Norton Children's Hospital was performed to identify patients with CHD who had cardiac surgery or intervention prior to one year of age. The rate of prenatal diagnosis prior to establishing any fetal tele‐echocardiography sites was compared to the rate of prenatal diagnosis after the sites were established. Independent t ‐tests were used to determine if there was a statistically significant increase in the rate of prenatal diagnosis. Results: 1287 patients had cardiac surgery or cath lab intervention prior to one year of age at our institution from June 2005 to December 2018 and were included in the analysis. Seventeen patients were excluded due to incomplete medical records. The rate of prenatal diagnosis prior to the implementation of the first fetal tele‐echocardiography site was 13.8% and after the sites were established, the prenatal diagnosis rate was 39.7% ( p < 0.01). Conclusion: Increasing the number of fetal tele‐echocardiography sites at small regional hospitals in Kentucky was associated with a statistically significant increase in the rate of prenatal diagnosis for patients less than 1 year of age who had cardiac surgery or cath lab intervention at Norton Children's Hospital in Louisville. Fetal tele‐echocardiography is an effective method to improve the rate of prenatal diagnosis in regions served by small regional hospitals with limited access to fetal echocardiography. Key points: What is already known about this topic? Prenatal diagnosis allows for improved management of Congenital heart disease (CHD) 1–4 Fetal tele‐echocardiography has been shown to be an effective means for prenatal diagnosis of CHD 5 It can be implemented in remote communities in an effort to improve access to care 6 What does this study add? It provides information on the effectiveness of fetal tele‐echocardiography for a regional program with multiple sites over an extended period of time. Provides analysis of a fetal tele‐echo program using local sonographers at each location and pediatric cardiologists at pediatric hospitals. It uses geographical mapping to provide information on the impact of each fetal tele‐echo location on the families that live close to a particular outreach site.