PM1031: Follow-up of Infants Diagnosed with Patent Foramen Ovale, Secundum Atrial Septal Defect, Muscular Ventricular Septal Defect, or Patent Ductus Arteriosus During Their Newborn Hospitalization

Background: Neonatal echocardiography is a vital tool in the early assessment of congenital heart disease, however many newborns have echocardiographic findings that may spontaneously resolve and the need for follow-up is unclear.

Objective: To describe the current management and follow-up of secundum atrial septal defect (ASD), patent foramen ovale (PFO), muscular ventricular septal defect (mVSD) and/or patent ductus arteriosus (PDA) identified during newborn hospitalization.

Methods: Infants who had an echocardiogram during their birth hospitalization and at least one echocardiogram in outpatient follow-up were identified. Echocardiograms performed between 9-1-17 and 9-1-21 were reviewed. Those newborns with findings limited to an ASD, PFO, mVSD and/or PDA were included. Those neonates where surgical correction was inevitable (atrioventricular canal, double outlet right ventricle, etc.) or with other cardiac defects requiring ongoing assessment (bicuspid aortic valve, rhabdomyoma, etc.) were excluded.

Results: 1091 newborns had echocardiograms during their birth hospitalization and 143 met inclusion criteria. Of those 143, none required any surgical intervention or catheterization during the study time frame. Forty-two infants were discharged from care. The most common indications for first echocardiograms were follow up of abnormal fetal echocardiogram (55 patients) and murmur (49 patients). The mean age at last echocardiogram was 96 days for those discharged and 128 days for those who had continued follow-up.

There was no significant difference in rate of discharge, number of follow-up echocardiograms, or age at last echocardiogram when compared by diagnosis at last echocardiogram at birth hospitalization (Table). Of 21 patients who had a PFO only on their last echocardiogram during birth hospitalization, only 7 were discharged from care during the time frame studied. Only 1 of 5 patients who had a PDA only was discharged from care. For all diagnoses included in this analysis, rates of discharge from care were below 40%.

Conclusion: No infants referred for outpatient follow-up in pediatric cardiology for PFO, ASD, and mVSD and/or PDA required any intervention during the study time frame. The majority of infants have continued follow-up scheduled but may not require surgical or procedural intervention in the future. Pediatric cardiologists may be continuing to follow patients for shunts that are unlikely to be clinically significant.