New guidelines aim to improve care for unborn babies with heart problems

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Foetal heart experts working with the American Heart Association have developed guidelines to help healthcare providers care for unborn babies with heart problems, as well as their families.

The statement “Diagnosis and treatment of fetal cardiac disease” is published in Circulation.

“Congenital heart disease is the most common birth defect that can result in either death or significant health problems in newborn babies,” says Mary T Donofrio, lead writer of the statement, and director of the Fetal Heart Program and Critical Care Delivery Service at Children’s National Medical Center, Washington DC, USA.

Foetal care is no longer solely the realm of high-risk obstetricians and neonatologists. A multidisciplinary specialty of foetal cardiology has emerged, according to the statement.

“We now have advanced imaging technologies, such as high-resolution ultrasound and three- and four-dimensional echocardiography, magnetic resonance imaging, foetal electrocardiography and magnetocardiography enabling physicians to diagnose foetal abnormalities early and with better detail and accuracy. Despite this, more than half of babies with congenital heart disease go undiagnosed before birth,” she says. “We created these guidelines to provide paediatric cardiologists, obstetricians, maternal foetal specialists, radiologists, nurses and other healthcare providers with the latest developments in the rapidly developing area of foetal cardiology.”

Among the recommendations in the statement:

  • Pregnant women with specific risk factors should be referred for foetal echocardiography. Women at risk include those who have had diabetes before pregnancy, diabetes diagnosed in the first trimester, have taken non-steroidal anti-inflammatory drugs (NSAIDs) in their third trimester, have congenital heart disease or a close relative with congenital heart disease, or other specific maternal medical conditions, and possibly those who conceived with in vitro fertilisation. Foetuses at risk include those identified with a chromosome problem or other abnormality, or those with a suspected heart problem. Foetuses diagnosed with a heart abnormality should be carefully monitored and healthcare providers should plan the delivery and post-delivery care that the baby will need.
  • Some foetal heart rhythm disturbances or heart function abnormalities can be treated with medicines given to the mother, which cross the placenta to reach the foetus. In-utero heart catheterisation and surgical procedures are being performed, however are still considered experimental.

The psychological effects and depression that may result when a pregnant woman and her family learns that their child has a congenital heart abnormality are also important factors for healthcare providers to consider. Parents often grieve upon learning that their unborn baby has a congenital heart condition. The authors note that it is important for providers to offer families information in an unbiased way, which not only addresses the condition and what is involved in treatment, but also whether children will be able to play sports, do well in school, and what kind of support they might need, physically and mentally. In addition, providers should help families overcome anxiety and depression, so they can transition from grief to acceptance and become active members of the team that care for their baby.

“This document transcends specialties and gives all healthcare providers that practice foetal cardiac medicine a standard for practice. This means improved care for babies with congenital heart disease, starting in the womb and continuing after delivery and through their lives,” said Donofrio.

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