Missed Congenital Heart Disease in Neonates

ABSTRACT Objectives. The purpose of this study was to determine the incidence of missed congenital heart disease in neonates in the state of Wisconsin leading to death or readmission during the first 2 weeks of life. Design. Wisconsin hospitalization and death records were reviewed from 2002 to 2006. Only those neonates discharged home after birth without a cardiac or major non‐cardiac diagnosis were considered. Wisconsin hospital records identified those neonates readmitted during the first 2 weeks of life with a diagnosis of heart disease using International Classification of Diseases, 9th Revision (ICD‐9) codes. Wisconsin death records also identified patients who died within the first 14 days of life who had a diagnosis of heart disease using International Classification of Diseases, 10th Revision (ICD‐10) codes. Adverse events were attributed to congenital heart disease if the diagnosis was a left‐sided obstructive lesion or a cyanotic heart defect. Other adverse events were attributed to heart disease if no other major diagnosis was present and the data suggested an intention to treat. The 114 Wisconsin hospitals, which delivered 340 203 babies during 2002–2006, were stratified into quartiles based on the total number of deliveries to determine if there was a difference in incidence of missed congenital heart disease based on hospital birth size. Results. Congenital heart disease led to death or rehospitalization during the first 2 weeks of life in 14 out of 345 573 births (1 : 24 684) in Wisconsin between 2002 and 2006. Coarctation of the aorta and hypoplastic left heart syndrome were the most common diagnoses. There did not appear to be a difference in the incidence of missed diagnosis of congenital heart disease based on the number of deliveries performed at the birth hospital. Conclusions. Death or readmission events in neonates under 2 weeks of age because of a missed diagnosis of congenital heart disease occurred in 1 : 24 684 neonates in the state of Wisconsin between 2002 and 2006. Critical left sided obstructive lesions were the most common cause of these events.