FETAL KARDİYOVASKÜLER ANOMALİLERİN PRENATAL TANILARININ, NEONATAL SONUÇLARININ, POSTNATAL KISA VE UZUN DÖNEM NÖROGELİŞİMSEL BULGULARININ RETROSPEKTİF OLARAK İNCELENMESİ

Abstract

Verim F. Retrospective Analysis of Prenatal Diagnoses, Neonatal Outcomes, and Short- and Long-Term Neurodevelopmental Findings in Fetal Cardiovascular Anomalies. Hacettepe University, Faculty of Medicine, Obstetrics and Gynecology Residency Thesis, Ankara, 2024. In recent years, with decreasing mortality rates among CHD patients which is one the most frequently observed anomaly, neurodevelopmental issues have emerged as significant comorbidities. This study presents a retrospective analysis of the neurodevelopmental outcomes of patients with fetal CHD diagnosis between 2005 and 2024 in the Department of Obstetrics and Gynecology at Hacettepe University. Neurodevelopmental disorders were classified based on the World Health Organization (WHO) International Classification of Impairments, Disabilities, and Handicaps into four categories: normal, mild, moderate, and severe. Children under 2 years of age, those born before 34 weeks of gestation and with genetic anomalies were excluded from the study, focusing on those with isolated CHD. Of the 115 CHD patients 61(53,1%) exhibited normal neurodevelopmental outcomes, while 54 (46,9%) presented with abnormal outcomes. When assessing the association of neurodevelopmental findings with CHD types, the incidence was found to be 83.4% in AVSD (n=5/6), 52.1% in left heart diseases (n=12/23), and 42.1% in conotruncal anomalies (n=24/46). Among CHD subgroups, the highest incidences were observed in AVSD (83.4%, n=5/6), HRHS (80%, n=4/5), DORV (77.7%, n=7/9), and HLHS (75%, n=3/4). The most frequently observed neurodevelopmental issues included motor skill deficits (17.2%), cognitive impairments (15.6%), and speech disorders (14.7%). While perioperative seizure history, CPR and ECMO need were identified as potential risk factors for neurodevelopmental outcomes, multivariate analysis did not yield any statistically significant associations. Counseling on possible mortality, morbidity and neurodevelopmental delay to families in the antenatal period is essential for aiding them in making informed decisions and preparing for challenges.