[Perinatal management of children with prenatal diagnosis of congenital heart defects].

During the recent years an increasing number of patients with congenital heart disease has been diagnosed prenatally by fetal echocardiography. The purpose of this study was to answer the question, which consequences will result from this prenatal information concerning the timing and mode of delivery as well as the neonatal treatment in these patients. From 12/1990 until 10/1994 21 neonates were treated in our center who had prenatal diagnosis of congenital cardiac malformation. In none of these patients we decided to change the timing or mode of delivery based on the hemodynamic findings of the cardiac malformation. Postnatally there was no evidence that this mode of delivery had a negative impact on the outcome in one of these neonates. All children, however, were delivered in a perinatal centre providing optimal perinatal care and early involvement of a pediatric cardiologist in the postnatal treatment. The perinatal treatment of patients with isolated ventricular or atrioventricular septal defects did not require specific intensive care measurements. On the other hand the majority of neonates with left heart, right heart or complex cardiac malformations required early intubation (81%), mechanical ventilation and intravenous administration of prostaglandin E1 (69%). Due to the prenatal diagnosis these measures were started before the adverse effects of ductal closure could lead to a hemodynamic deterioration in these patients. Despite this treatment 11/21 patients (52%) died in the neonatal period or in early infancy. Based on our experience we do not propose a change in the mode of delivery in the majority of children with prenatal diagnosis of congenital cardiac malformations. For further improvement in the perinatal treatment of children with congenital heart disease a close cooperation of gynecologists, neonatologists and pediatric cardiologists as well as concentration of those patients to perinatal centres will be necessary.