Improving prediction of critical coarctation of the aorta in neonates: Key parameters and a novel scoring system.

BACKGROUND

Coarctation of the aorta (COA) is a congenital heart defect that is difficult to diagnose prenatally due to high false-positive and false-negative rates. Postnatal assessment is further complicated by a patent ductus arteriosus (PDA), which can mask COA. This study evaluated outcomes and developed a predictive model based on early postnatal echocardiography.

METHODS

We retrospectively analyzed neonates with prenatal suspicion of COA admitted from 2019 to 2022, excluding complex heart defects. Echocardiography was performed within 24 h after birth. Intervention was defined as the need for surgery. Multivariate analysis was used to develop the Neonatal-COA Intervention Score (N-CIS), which was prospectively validated in a 2022-2024 cohort.

RESULTS

Among 47 neonates, 25 (53%) required surgery for critical COA, while 19 (40.4%) had no COA at follow-up. The intervention group had lower distal transverse arch-to-descending aorta diameter ratio (T/D) (OR, 0.40) and isthmus-to-descending aorta diameter ratio (I/D) (OR, 0.31), as well as a higher frequency of a posterior shelf (OR, 31.5; all P < 0.01). The N-CIS achieved 92% sensitivity and 81.8% specificity at a cut-off of 1.5 (area under the curve, 0.905). In 42 validation cases, sensitivity and specificity were 94.4% and 100%, respectively; all with scores greater than or equal to 1.5 required surgery.

CONCLUSION

The N-CIS demonstrated high accuracy in predicting critical COA, supporting early risk stratification and timely intervention.