Impact Of Perinatal And Neonatal Risk Factors, Including Fetal Echocardiography Referral, On Echocardiographic Abnormalities In Neonates: A Cross-Sectional Study Of 1062 Patients

Abstract

Background: Congenital heart defects (CHDs) are the most frequent congenital anomalies, contributing substantially to neonatal death and morbidity. While fetal echocardiography is increasingly used for antenatal detection, its diagnostic yield varies, and the contribution of perinatal and neonatal risk factors remains uncertain.

Objective: To assess the impact of perinatal and neonatal risk factors, including fetal echocardiography referral, on echocardiographic abnormalities in neonates.

Methods: This cross-sectional study included 1062 neonates born in 2024 who underwent transthoracic echocardiography at Prince Sultan Cardiac Center, Saudi Arabia. Perinatal and neonatal data—including gestational maturity, infant of diabetic mother (IDM) status, mode of delivery, NICU admission, dysmorphic features, and fetal echocardiography referral—were collected from medical records. Echocardiograms were performed by pediatric cardiologists and classified as normal or abnormal. Statistical analyses involved logistic regression and chi-square/Fisher’s exact tests.

Results: Echocardiographic abnormalities were identified in 69 neonates (6.5%). NICU admission was significantly associated with abnormal echocardiograms (p = 0.004), whereas maturity, IDM status, mode of delivery, dysmorphic features, and fetal echocardiography referral showed no significant associations. Logistic regression analysis confirmed that none of the studied variables were independent predictors of neonatal CHD.

Conclusion: Echocardiographic abnormalities were present in 6.5% of neonates, with NICU admission being the only associated factor. Neither fetal echocardiography referral nor other perinatal variables predicted neonatal CHD. These findings support targeted postnatal echocardiographic screening for NICU-admitted neonates and highlight the need for multicenter studies to refine risk stratification.