Improving the prenatal detection of critical congenital heart disease (CCHD) across Ireland – investigation of current policies and implementation of a national consensus- based targeted fetal echocardiography screening strategy

<p dir="ltr">Approximately 150 babies are born with critical congenital heart disease (CCHD) in Ireland every year. In majority of cases, they are born to mothers with no risk factors in otherwise uncomplicated pregnancies. Survival, short-term and long-term health of these babies is dependent on timely recognition and urgent transfer to the National Children’s Cardiac Centre in CHI (Children’s health Ireland) @Crumlin. This is best achieved where the heart abnormality is identified during pregnancy, with a skilled prenatal ultrasound examination. The efficiency of obstetric ultrasound for detection of CCHD is crucial in identifying these babies and is influenced by many factors, including scanning technology, maternal body habitus, fetal lie and operator interpretation. All 19 maternity units in the republic of Ireland are staffed and equipped to provide prenatal screening by providing a mid-trimester anatomy scan at 20 weeks' gestation, but there exists an urgent need for a formal screening programme specifically for CCHD that incorporates quality assurance initiatives, an educational package and care pathway bundle that ensures optimal detection and perinatal management for all babies with a diagnosis of CCHD.</p><p dir="ltr">Poor outcomes are common, particularly when babies are born remote from Dublin as the neonates’ ability to circulate oxygenated blood becomes difficult after birth. Detection before birth gives parents time to process the information, as it can be complex. It also allows them to meet the specialists who will be involved in their infant’s care and to plan for delivery. The delivery may need to be organised in a hospital close to a Paediatric cardiac unit to allow for urgent care of the baby after birth.</p><p dir="ltr">We propose to investigate the current detection rates of CCHD and barriers that exist. Improving the detection rate of CHD in Ireland by providing education and support for sonographers and doctors at a national level tasked with examining the fetal heart is the ultimate goal of this project.</p>