Occurrence and Antenatal Detection of Congenital Heart Malformations: Data from a Tertiary Obstetric Centre in Western Romania

Introduction: Congenital heart defects (CHDs) are the most frequent group of major congenital anomalies and impose a disproportionate burden on neonatal services. Antenatal detection determines where and how an affected newborn is delivered, yet reported detection rates differ several-fold between European countries. We aimed to quantify the postnatal occurrence and the antenatal detection of CHDs in a tertiary obstetric center in Western Romania and to place both figures in a comparable international context. Material and Methods: Retrospective observational study of all 10,113 births registered at the “Pius Brînzeu” County Clinical Emergency Hospital, Timișoara, between 2018 and 2022. Newborns with at least one cardiac lesion recorded on indication-based postnatal echocardiography were identified from the hospital electronic record. Interatrial communications and ductal patency recorded at the neonatal-index examination were counted inclusively and are analyzed separately from structural defects. A defect was classified as antenatally detected when it had been reported at any prenatal ultrasound scan and was subsequently confirmed postnatally. Proportions are reported with Wilson score 95% confidence intervals (CIs), separately at the level of the newborn and at the level of the individual lesion. Results: A total of 541 newborns carried at least one recorded cardiac lesion, giving an occurrence of 5.35% of births (95% CI 4.93–5.81); 670 individual lesions were recorded, a mean of 1.24 per affected newborn. Interatrial communication (n = 319; 47.6% of lesions) and ductal patency (n = 90; 13.4%) accounted for 61.0% of lesions; among the 261 structural defects, ventricular-septal defect was the most frequent (n = 121; 46.4%). An antenatal diagnosis had been made in 151 of 541 newborns (27.9%; 95% CI 24.3–31.8). Detection was highest for lesions distorting the four-chamber view, hypoplastic left-heart syndrome 4/5, and ventricular septal defect 80/121 (66.1%; 95% CI 57.3–73.9), and lowest for lesions requiring outflow-tract or arch views, including pulmonary stenosis 3/27 (11.1%; 95% CI 3.9–28.1) and aortic stenosis 0/12. Restricting the count to structural defects gives 13.1 to 25.8 affected newborns per 1000 births, against a EUROCAT total prevalence of 8.0 per 1000. Conclusions: The occurrence recorded here reflects tertiary referral, indication-based echocardiography, and an inclusive case definition rather than a genuine population excess, and is not interchangeable with registry prevalence. The antenatal detection rate of 27.9% sits between European settings without organized screening and those performing two or three routine scans per pregnancy. The detection deficit is concentrated in lesions that require outflow-tract or arch views. Because the views obtained at each scan were not recorded and detection was not stratified by prenatal-care status, the contribution of examination protocol and of access to care is inferred rather than demonstrated; both are testable hypotheses for a prospective, protocolized study.