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Dr.Muhammad Rehan Akhtar

United Kingdom

Title: Are The Babies With Congenital Heart Disease Born In The Right Place At The Right Time? – Practices in Yorkshire and Humber.

Biography

Biography: Dr.Muhammad Rehan Akhtar

Abstract

Authors: M R Akhtar (Leadership Fellow Yorkshire and Humber Congenital Heart Disease Network), L Miall (Neonatal Co-Lead for Yorkshire and Humber Congenital Heart Disease Network).
 
Institutions: Leeds Teaching Hospitals, Yorkshire and Humber Congenital Heart Disease Network.
 
Background: 
Advances in prenatal screening have enabled earlier identification of congenital heart disease (CHD). This enables planned deliveries at hospitals with specialized cardiac and neonatal care, improving neurodevelopmental outcomes in neonates. In October 2021, the Yorkshire and Humber Congenital Heart Disease Network developed a guideline aimed at providing guidance on the timing and location of delivery for babies with antenatal diagnosis of CHD. We aimed to assess compliance with the guideline and evaluate the extent of improvement in delivery practices that have been implemented in accordance with the guideline.
 
Methods: 
We conducted a retrospective audit analyzing data for infants born between May 2021 and April 2022, specifically examining a period of 6 months before and 6 months after the guideline publication. 
This review was carried out in the cardiac centre using electronic patient records (PPM+ and Badger Net) and the local data provided by regional paediatricians with expertise in cardiology. 
 
Results:
There were 166 live births of babies with CHD in the region during the study period.
 
Before the guideline: 
- Cardiac Centre: median gestational age was 38+2 (30+6 – 40+0). 
- Local: median gestational age was 38+0 (32+4 – 41+0). 
- 8% of babies were delivered outside their planned delivery destination. 
- All planned palliative care was achieved in local hospitals. 
 
After the guideline: 
- Cardiac Centre: median gestational age was 38+3 (27+0 – 40+1). 
- Local: median gestational age was 38+1 (26+5 – 40+4). 
- 5% of babies were delivered off-pathway. 
- 80% of planned palliation was achieved locally.
 
Conclusion:
There was a 1-day increase in median gestational age at birth across the region and a slight improvement in the number of babies born off-pathway following the guideline. Obstetric emergencies and parental wishes were drivers of off-pathway deliveries. Good communication between professionals and institutions, parental counselling and reassurance could improve off-pathway deliveries.