Heart disease presenting in the first week of life: implications of advances in diagnosis and management since 1973

The spectra of congenital heart diseases presenting in the first week of life - diagnosis, treatment, and prognosis - were analyzed in a recent series and compared with a series 9 years earlier. Eighty percent of all infants aged 0 to 7 days referred to the pediatric cardiology service in these series had actual cardiovascular defects; 42% had critical cardiovascular disease. Use of echocardiography in the neonate with suspected congenital heart disease increased from 0 to 82% in the 9-year period, whereas, frequency of cardiac catheterization decreased. Treatment with prostaglandin E(1) and catecholamine-derived pressor agents increased. Surgical mortality in critical neonatal heart disease fell from 58 to 18%, whereas, early cardiac deaths fell from 49 to 24%. These findings illustrate a favorable trend in the care of the neonate with congenital heart disease based on less hazardous diagnostic methods, more effective medical stabilization, and advances in surgical technique.