1. Network audit and quality improvement
Dr Elspeth Brown
Network clinical lead

2. Network audits
Approx 10 years ago: audit of new patients in clinic and outcomes
2016: retrospective audit of previous 5 years patients transitioned and lost to follow up
2017: audit of antenatal diagnosis rates

3. Fetal audit Antenatal diagnosis rate 2017
Dr R Newbegin ST7 Paediatrics
Dr E Brown Consultant

4. CCAD - NICOR
Antenatal Diagnosis Evidence suggests that antenatal diagnosis of major congenital heart disease improves outcomes, particularly from the point of view of serious morbidity such as brain damage. For the purposes of comparative audit of antenatal diagnosis we have chosen to analyse data only for babies who require surgery or therapeutic catheterisation during the first year of life, excluding those with patent ductus, patent foramen ovale or atrial septal defect, as these conditions are not diagnosed antenatally. The NICOR Congenital dataset contains only one simple piece of information concerning antenatal diagnosis – whether the heart abnormality was detected antenatally or not.
We present data on the percentage of patients being treated by surgery or intervention in the first year of their life, in each cardiac centre, in cases with this data field properly completed. The value shown is the percentage of eligible cases that were successfully diagnosed antenatally.
Please note this is not the same as the overall antenatal detection rate as it does not take into account deaths during pregnancy or peri-natal deaths or where the condition is less severe and does not require treatment in the first 12 months or where a decision is made not to intervene due to the complexity of the heart abnormality or associated comorbidities.
Results are averaged over a 5 year period and also shown for the most recent full year available.

5. NICOR – Antenatal detection rates 2013-2016

6. Leeds data 2017

7. Antenatal diagnosis rate 2017
Total number of children < 1 year who had surgery or intervention in 2017 (excluding PDA)
173
Data analysed for 172
1 exclusion (one born in Kuwait)
Antenatally diagnosed 91
Not antenatally diagnosed 81
Antenatal diagnosis rate 52.9%

8. Demographics ETHNICITY Postnatal Antenatal Caucasian 63 64 Black 213 16
Other 8
Unknown 1
Demographics
GENDER
Postnatal
Antenatal
Female 32 37
Male 49 54

9. Red – Postnatal diagnosis Blue – Antenatal diagnosis
Harrogate baby born in Kuwait (ignore)
Red – Postnatal diagnosis
Blue – Antenatal diagnosis

10. No antenatal diagnosis
Aortic arch hypoplasia + coarctation 9 5
One of above + VSD or ASD 6
Coarctation + double aortic arch 1
Double aortic arch 2
Valvar lesions (AS, MR, TR)
VSD 24
VSD + other (RVOTO or valve abnormality) 3
Tetralogy of Fallot 19 12
DORV + other
AVSD 4 10
AVSD + arch hypoplasia/coarctation
TGA
TGA + other (biventricular repair)
Truncus
ccTGA + other
HLHS
Complex single ventricle 8 PA
Absent pulmonary valve syndrome
TAPVD
PAPVD
ALCAPA
AN diagnosis details
VSD + other TR
R aortic arch
AVSD + other
Arch hypoplasia/coarctation x 2
TGA + other
Interruption (biV repair)
Pulmonary atresia (BiV repair)
DORV (biventricular repair)
DORV + other
Coarctation/hypoplasia x 2 (? Could go under VSD section)
PA (biventricular repair)
Single ventricle
DORV + MA, PA
TGA + DILV
TGA + DILV, arch hypoplasia
TGA + Tricuspid atresia
AVSD + PA, TAPVD, R isomerism
DILV + DOLV
TA, PA, TAPVD, R isomerism TA
ccTGA + other
DORV
VSD

11. Antenatal and postnatal diagnoses

12. Antenatal and postnatal diagnoses

13. Post natal diagnosis by area

14. East Yorkshire – post natal diagnosis
VSD
VSD, ASD, CoA
Supracardiac TAPVD
Lesions which are easily missed antenatally

15. Manchester – post-natal diagnosis
Tetralogy of Fallot

16. Lincoln – post-natal diagnosis
MR, TR, PPHN (had mitral valve replacement)
Tetralogy of Fallot *
Double aortic arch, vascular ring*
Aortic arch hypoplasia, coarctation, multiple VSDs*
Coarctation, bicuspid aortic valve *

17. Futures
What should we be looking at?

19. Thank You