Cardiac-related neonatal collapse presenting to the emergency department: a retrospective cohort study
Background To describe the characteristics of cardiac-related neonatal collapses referred to a critical care transport service and evaluate the diagnostic accuracy and management at referral and retrieval.Methods Retrospective cohort analysis of cardiac-related neonatal collapses who were referred t...
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| Language: | English |
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BMJ Publishing Group
2025-02-01
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| Series: | BMJ Paediatrics Open |
| Online Access: | https://bmjpaedsopen.bmj.com/content/9/1/e003149.full |
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| author | Jon Lillie Manson Chon In Kuok Jennie Lambert Anitha Janjanam |
| author_facet | Jon Lillie Manson Chon In Kuok Jennie Lambert Anitha Janjanam |
| author_sort | Jon Lillie |
| collection | DOAJ |
| description | Background To describe the characteristics of cardiac-related neonatal collapses referred to a critical care transport service and evaluate the diagnostic accuracy and management at referral and retrieval.Methods Retrospective cohort analysis of cardiac-related neonatal collapses who were referred to and transferred by a paediatric intensive care retrieval team based in London, UK between 2013 and 2021. Patients with antenatal diagnoses were excluded.Results There were 71 neonates identified of whom 49 (69%) had structural heart defect, 12 (17%) arrhythmia and 10 (14%) with cardiomyopathy/myocarditis. Among structural defects, left ventricular outflow tract (LVOT) obstruction (71%) and mixing of circulation (22%) were the predominant pathologies. Cardiac murmur was absent in 66% of the patients. The referring teams’ diagnostic performance was suboptimal for LVOT obstruction and cardiomyopathy/myocarditis, with 63% and 30% recognised as cardiac cause of collapse at referral. Less than half of neonates with duct-dependent lesions received prostaglandin at referral, which later improved to 97% during retrieval. The number of patients requiring intubation and inotropic support also increased at various time points throughout the patient journey. 98% of patients with structural defects required cardiac interventions at a median of 1 day after admission.Conclusions Structural heart defect, particularly LVOT obstruction, was the leading cause of cardiac-related neonatal collapses. However, a significant portion were initially misdiagnosed leading to delay in prostaglandin administration. Our findings highlight the importance of a high index of suspicion for cardiac pathologies as a cause of neonatal collapse, which is essential for appropriate treatment and timely referral. |
| format | Article |
| id | doaj-art-aa949f4980f24a8483fbb3cefd8f2aca |
| institution | DOAJ |
| issn | 2399-9772 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Paediatrics Open |
| spelling | doaj-art-aa949f4980f24a8483fbb3cefd8f2aca2025-08-20T03:05:45ZengBMJ Publishing GroupBMJ Paediatrics Open2399-97722025-02-019110.1136/bmjpo-2024-003149Cardiac-related neonatal collapse presenting to the emergency department: a retrospective cohort studyJon Lillie0Manson Chon In Kuok1Jennie Lambert2Anitha Janjanam3Paediatric Intensive Care Unit, Evelina London Children`s Hospital, London, UKPaediatric Intensive Care Unit and South Thames Retrieval Service, Evelina London Children’s Hospital, London, UKPaediatric Intensive Care Unit and South Thames Retrieval Service, Evelina London Children’s Hospital, London, UKPaediatric Intensive Care Unit and South Thames Retrieval Service, Evelina London Children’s Hospital, London, UKBackground To describe the characteristics of cardiac-related neonatal collapses referred to a critical care transport service and evaluate the diagnostic accuracy and management at referral and retrieval.Methods Retrospective cohort analysis of cardiac-related neonatal collapses who were referred to and transferred by a paediatric intensive care retrieval team based in London, UK between 2013 and 2021. Patients with antenatal diagnoses were excluded.Results There were 71 neonates identified of whom 49 (69%) had structural heart defect, 12 (17%) arrhythmia and 10 (14%) with cardiomyopathy/myocarditis. Among structural defects, left ventricular outflow tract (LVOT) obstruction (71%) and mixing of circulation (22%) were the predominant pathologies. Cardiac murmur was absent in 66% of the patients. The referring teams’ diagnostic performance was suboptimal for LVOT obstruction and cardiomyopathy/myocarditis, with 63% and 30% recognised as cardiac cause of collapse at referral. Less than half of neonates with duct-dependent lesions received prostaglandin at referral, which later improved to 97% during retrieval. The number of patients requiring intubation and inotropic support also increased at various time points throughout the patient journey. 98% of patients with structural defects required cardiac interventions at a median of 1 day after admission.Conclusions Structural heart defect, particularly LVOT obstruction, was the leading cause of cardiac-related neonatal collapses. However, a significant portion were initially misdiagnosed leading to delay in prostaglandin administration. Our findings highlight the importance of a high index of suspicion for cardiac pathologies as a cause of neonatal collapse, which is essential for appropriate treatment and timely referral.https://bmjpaedsopen.bmj.com/content/9/1/e003149.full |
| spellingShingle | Jon Lillie Manson Chon In Kuok Jennie Lambert Anitha Janjanam Cardiac-related neonatal collapse presenting to the emergency department: a retrospective cohort study BMJ Paediatrics Open |
| title | Cardiac-related neonatal collapse presenting to the emergency department: a retrospective cohort study |
| title_full | Cardiac-related neonatal collapse presenting to the emergency department: a retrospective cohort study |
| title_fullStr | Cardiac-related neonatal collapse presenting to the emergency department: a retrospective cohort study |
| title_full_unstemmed | Cardiac-related neonatal collapse presenting to the emergency department: a retrospective cohort study |
| title_short | Cardiac-related neonatal collapse presenting to the emergency department: a retrospective cohort study |
| title_sort | cardiac related neonatal collapse presenting to the emergency department a retrospective cohort study |
| url | https://bmjpaedsopen.bmj.com/content/9/1/e003149.full |
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