Impact of COVID-19 on Prenatal Diagnosis and Surgical Outcomes of Congenital Heart Disease: Fetal Heart Society and Society of Thoracic Surgeons Collaborative Study

Bhawna Arya, Department of Pediatrics Seattle Children's Hospital and the University of Washington School of Medicine Seattle WA USA.
Miza Salim Hammoud, Division of Pediatric Cardiac Surgery, Heart, Vascular & Thoracic Institute Cleveland Clinic Cleveland OH USA.
Andrew J. Toth, Department of Quantitative Health Sciences Cleveland Clinic Cleveland OH USA.
Joyce Woo, Division of Cardiology Ann & Robert H. Lurie Children Hospital of Chicago and Northwestern University Feinberg School of Medicine Chicago IL USA.
Matthew Campbell, Department of Pediatrics Texas Children's Hospital, Baylor College of Medicine Houston TX USA.
Angira Patel, Division of Cardiology Ann & Robert H. Lurie Children Hospital of Chicago and Northwestern University Feinberg School of Medicine Chicago IL USA.
Lindsay A. Edwards, Department of Pediatrics, Division of Pediatric Cardiology Duke University School of Medicine Durham NC USA.
Lindsay Freud, Division of Cardiology, The Hospital for Sick Children University of Toronto Toronto Canada.
Rupali Gandhi, Division of Cardiology, Advocate Children's Hospital Oak Lawn IL USA.
Anita Krishnan, Division of Cardiology, Children's National Hospital George Washington University School of Medicine, and Health Sciences Washington DC USA.
Shabnam Peyvandi, Department of Pediatrics University of California San Francisco CA USA.
Nelangi Pinto, Department of Pediatrics Seattle Children's Hospital and the University of Washington School of Medicine Seattle WA USA.
Christina Ronai, Department of Cardiology, Boston Children's Hospital, Department of Pediatrics Harvard Medical School Boston MA USA.
Kristen Sexson Tejtel, Department of Pediatrics Texas Children's Hospital, Baylor College of Medicine Houston TX USA.
Anita Moon-Grady, Department of Pediatrics University of California San Francisco CA USA.
Mary T. Donofrio, Division of Cardiology, Children's National Hospital George Washington University School of Medicine, and Health Sciences Washington DC USA.
Shubhika Srivastava, Department of Cardiovascular Services Center for Cardiovascular Research and Innovation Nemours Children's Health Wilmington DE USA.
Tara Karamlou, Division of Pediatric Cardiac Surgery, Heart, Vascular & Thoracic Institute Cleveland Clinic Cleveland OH USA.

Document Type

Journal Article

Publication Date

5-6-2025

Journal

Journal of the American Heart Association

Volume

14

Issue

9

DOI

10.1161/JAHA.124.037079

Keywords

COVID‐19 impact; fetal cardiology; neonatal critical congenital heart disease outcomes

Abstract

BACKGROUND: Fetal echocardiography is the mainstay of prenatal diagnosis of congenital heart disease. The COVID-19 pandemic led to shifts in triage of prenatal services. Our objective was to evaluate the impact of COVID-19 restrictions on prenatal diagnosis, surgical outcomes, and disparities in neonatal critical congenital heart disease (CCHD) management in the United States during the pandemic's first year. METHODS AND RESULTS: A multi-institutional retrospective cohort study compared neonatal CCHD outcomes (requiring surgery within 60 days of birth) 1 year prior (prepandemic era) and during the peak pandemic era, supplemented by a Fetal Heart Society survey assessing regional practice changes. Data on prenatal diagnosis, demographics, outcomes, and 2020 state Area Deprivation Index were analyzed using Wilcoxon rank sum and χ tests. The survey, completed by 72 fetal cardiologists from 9 US census regions, showed 75% of institutions implemented restrictions by March 2020, affecting triage, referrals, and number of prenatal cardiology visits. Compared with CCHD neonates born prepandemic (n=4637), those born during the pandemic (n=1806) had a higher proportion of prenatal diagnosis (66% versus 63%, P<0.05). There were no significant differences in complications or mortality, but pandemic-era neonates had longer hospital stays. During the pandemic, CCHD neonates had a more disadvantaged Area Deprivation Index and had surgery at hospitals located in more advantaged regions. CONCLUSIONS: Although pandemic-driven care delivery adjustments affected perinatal cardiology referrals and triage, prenatal diagnosis, perioperative outcomes, and survival remained robust. The management of CCHD demonstrates health care resilience, maintaining core prenatal and perioperative care. Regional variations highlight the need for targeted strategies to address disparities during health care crises.

Department

Pediatrics

Link to Full Text

Share

COinS