An update work of pulse oximetry screening for detecting critical congenital heart disease in the newborn

BACKGROUND

Congenital Heart Disease (CHD) is the commonest group of congenital malformations and affects 7-8 per 1000 live born newborns. Nevertheless, it is estimated that more than 50% of babies with undiagnosed CHD are not detected by routine neonatal cardiac examination.

AIM

To find the incidence of CHD in newborns and to determine the accuracy of pulse oximetry for detecting clinically unrecognized critical congenital heart disease (CCHD) in the newborns.

METHODS

Pulse oximetry was performed on clinically normal newborns within 4 hours of first day of life. Inclusion criteria: All newborns who were admitted in postnatal ward & Neonatal Intensive care unit (NICU). Exclusion criteria: babies and neonates with a prenatal diagnosis of duct dependent circulation. If oxygen saturation (SpO₂) was below 90%, then echocardiography was performed.

RESULTS

During the study period, 4926 live born neonates were examined. Nine out of 12 neonates with SpO2<90% had CCHD. Four neonates had tetralogy of Fallot (TOF), two had tricuspid atresia, two had transposition of great arteries (TGA) and one had truncus arteriosus. The incidence of CHD was 33.49 per 1000 live births and CCHD was 1.82 per 1000.  A pulse oximetry cut-off value of below 90% for detecting CCHD showed 90% sensitivity, 99.94% specificity, 75% positive predictive value (PPV) and 99.98% negative predictive value (NPV).

CONCLUSION

Pulse oximetry is safe, feasible and noninvasive and also used to screen for CCHD. It is the nice method to detect the CHD along with the physical examination of neonates by medical personal.

Rare Presentation of Cerebral Venous Sinus Thrombosis in a Child

Cerebral venous sinus thrombosis (CVST) is a critical condition with significant morbidity and mortality. It primarily affects the young and healthy. CVST presents a diagnostic challenge due to its varied presentation patterns. We report the case of a 11-year-old boy diagnosed with CVST after presenting with a long history of continuous headache. He improved following anticoagulation therapy. Despite thorough investigation, no discernible underlying cause could be identified.

Comparison Between Automated and Manual Sphygmomanometer for Measuring Blood Pressure in Children

Introduction: The mercury sphygmomanometer has been the gold standard used for obtaining blood pressure (BP). However, due to environmental concerns and more use of automated BP devices, an alternative to using the standard mercury sphygmomanometer to measure BP. The aim of this study is to evaluate the accuracy of the Automated (Omron) BP device against the mercury sphygmomanometer in children.Material and Methods: One hundred children were enrolled in this study. The accuracy of Omron HEM–7121 BP readings was compared with that of mercury BP device readings. Each children had four BP measurements recorded sequentially i.e. two valid systolic readings, and two valid diastolic readings.Results: BP taken with the automated device was systolic 109.77 ± 9.97 and diastolic 74.50 ± 8.32 mm Hg compared to systolic 112.68 ± 9.98 and diastolic 77.38 ± 7.91 mm Hg measured by manual mercury sphygmomanometer BP readings (p<0.001). Automated and mercury BP measurements were correlated (r = 0.89, systolic BP; r = 0.82, diastolic BP). Linear regression analysis showed that the automated systolic BP is a significant predictor (? = 0.897, p < 0.001) of manual systolic BP. Similarly, automated diastolic BP was also a significant predictor (? = 0.829, p< 0.001) of manual diastolic BP.Conclusion: This study concludes that the automated BP device is reliable and accurate for measuring the BP in children.J Nepal Paediatr Soc 2015;35(1):13-17

Unicuspid Aortic Valve in Infant

The unicuspid aortic valve (UAV) is a very rare congenital anomaly, which usually presents as aortic stenosis, incompetence, or a combination of both. Here, we present a case of UAV with moderate aortic stenosis detected by transthoracic echocardiography in the infant.

Is it reliable to measure the forearm blood pressure in children?

Background:

When the upper arm (UA) is inaccessible or a standard-sized blood pressure (BP) cuff is unavailable, some healthcare workers use the forearm (FA) to measure BP with a mercury sphygmomanometer.

Objective:

The objective was to determine the accuracy of BP measurement in the arm and FA.

Design:

Prospective, randomized study.

Setting:

Department of Pediatrics, JNMC, Sawangi (Meghe)

Participants:

A total of 72 children aged 5–15 years.

Measurements:

Mercury and Automatic (OMRON Tokyo, 108-0075 Japan) BP measurements were recorded from the arm and FA at 2 min intervals.

Results:

In our study, 72 children of both sexes were enrolled. The mean age of the children was 10.13 ± 2.82 years, and 48% were females. Pearson's correlation coefficient between FA and UA systolic BP (SBP) measured by mercury was 0.782, and for diastolic BP (DBP) it was 0.824. Similarly, Pearson's correlation coefficient between FA and UA SBP measured with an automated device (OMRON) was 0.843, and for DBP it was 0.846. The average readings for the SBP and DBP were higher in the FA than in the UA by approximately 3 mmHg. There was a statistically significant difference in both SBP and DBP.

Conclusions:

The FA is an acceptable method of BP monitoring when the UA cannot be accessed. The pressure from FA is probably higher than it would be from UA.

Uhl's Anomaly with Absent Tricuspid Valve in an Infant

Uhl's anomaly is characterized by absence of the myocardial layer of the right ventricle, with opposition of the endocardium and epicardium. It is rarely associated with other congenital malformation. Here, we reported the rare association of Uhl's anomaly with absent tricuspid valve in an infant.

Wildervanck syndrome with hypoplastic frontal sinus: A rare case presentation

We report a case of Wildervanck syndrome exhibiting Klippel-Feil anomaly, Duane's retraction syndrome and congenital deafness. Since the first case was reported in 1952, there have been more reports describing this triad either complete or incomplete. Our case has a complete triad of the syndrome along with frontal sinus hypoplasia. Our case is unique as the triad was associated with frontal sinus hypoplasia, which is very rare association.

A case report of ectopia cordis and omphalocele

A rare congenital defect in fusion of the anterior chest wall resulting in an extrathoracic location of the heart. Cantrell's pentalogy is a congenital anomaly resulting from embryologic development defect and consists of the following: A deficiency of the anterior diaphragm, a midline supraumbilical abdominal wall defect, a defect in the diaphragmatic pericardium, congenital intracardiac abnormalities, and a defect of the lower sternum. Here we report a rare case of ectopic cordis with omphalocele.

Oculoauriculovertebral spectrum with radial anomaly in child

Oculoauriculovertebral spectrum (OAVS) or Goldenhar syndrome is a wide spectrum of congenital anomalies that involves structures arising from the first and second branchial arches. It is characterized by a wide spectrum of symptoms and physical features. These abnormalities mainly involve the cheekbones, jaws, mouth, ears, eyes, or vertebrae. Other conditions with ear and/or radial involvement, such as, the Nager syndrome, Holt-Oram syndrome, Radial–renal syndrome, facioauriculoradial dysplasia, Fanconi anemia, and Vertebral, Anal atresia, Cardiac, Trachea, Esophageal, Renal, and Limb (VACTERL) association should be considered for differential diagnosis. Here we report a child who had facial asymmetry, microsomia, microtia, congenital facial nerve palsy, conductive hearing loss, skin tags, iris coloboma, and preaxial polydactyly.

Study of Risk Factor for Congenital Heart Diseases in Children at Rural Hospital of Central India

Introduction: Congenital heart disease is the most common congenital problem that accounts for up to 25% of all congenital malformations. Hence this study was aimed at improving the knowledge related to risk factors associated with CHD in a rural Indian scenario. It was a hospital- based case control study. Materials and Methods: The children up to twelve year of age with clinical suspicion of CHD were subjected to chest x-ray and electrocardiography, and final diagnosis was confirmed by echocardiography (n=209) as cases. The control group (n=418) were randomly selected from children without CHD who were admitted during the same period. The etiological factors like environmental, infections, drugs, and maternal factors were analyzed by using EPI 6 version. Results: In cases group, 56% were male and 44% female children. 82% cases presented at age of less than 5 years and 18% after 5 year. Exposure to smoking (OR=10.45), tobacco intake by mother (OR=8.28) and family history of CHD (OR=7.21) were the significant risk factor present in cases. Conclusion: The risk factors for CHD child identified were exposure to smoking and tobacco intake by mother, family history of CHD, antenatal infection in 1st trimester and history of diabetic mother. DOI: http://dx.doi.org/10.3126/jnps.v33i2.8254   J Nepal Paediatr Soc. 2013; 33(2):121-124

Accuracy of pulse oximetry screening for detecting critical congenital heart disease in the newborns in rural hospital of Central India

BACKGROUND

Congenital cardiovascular malformations are the most common category of birth defects and responsible for mortality in the first twelve months of life. Critical congenital heart disease (CCHD) will be present in approximately one quarter of these children, which requires catheter or surgery intervention in the first year of life.

AIM

To determine the accuracy of pulse oximetry for detecting clinically unrecognized CCHD in the newborns.

METHODS

Pulse oximetry was performed on clinically normal newborns within first 4 hours of life. If screening oxygen saturation (SpO2) was below 90%, echocardiography was then performed.

INCLUSION CRITERIA

All newborns who were admitted in postnatal ward & NICU.

EXCLUSION CRITERIA

Out born babies and babies with a prenatal diagnosis of duct dependent circulation.

RESULTS

Pulse-oximetric screening was performed on 2110 clinically normal newborns. Low SpO2 (<90%) was found in eight babies seven of them had CCHD, including three neonates with TGA, two with tricuspid atresia, one with tetralogy of fallot and one with transposition of great vessels. A pulse oximetry cut-off value of below 90% for detecting CCHD showed 100% sensitivity, 99.95% specificity, 87.50% positive predictive value, 100% negative predictive value.

CONCLUSIONS

Pulse oximetry is safe, feasible and noninvasive, can be used as screening tool for detecting CCHD in clinically normal newborn. If SpO2 is below 90% in clinically normal newborns within 4 hours of birth, urgent echocardiography is suggested to rule out CCHD.

Unusual manifestation of Marden-Walker syndrome

Marden-Walker syndrome (MWS) is characterized by multiple joint contractures, a mask-like face with blepharophimosis, micrognathia, high-arched or cleft palate, low-set ears, decreased muscular bulk, arachnodactyly, and kyphoscoliosis. We report a case of MWS along with unusual manifestation of neurological, cardiovascular, and genitourinary system.

Staphylococcal Scalded Skin Syndrome in an Infant

Staphylococcal scalded skin syndrome is a bullous disease of the skin caused by toxins (exfoliatins) secreted by certain types of Staphylococcus aureus. These toxins may act as superantigens, stimulating the proliferation of T lymphocytes, with a massive release of cytokines and consequent epidermal damage. In neonates, the lesions are mostly found on the perineum or periumbilically, while the extremities are more commonly affected in older children. The disease begins with erythema and fever, followed by formation of large fluid filled bullae which quickly rupture on slightest pressure to leave extensive areas of denuded skin. We present a case of staphylococcal scalded skin syndrome in infant. J Nepal Paediatr Soc 2012;32(2):178-180 doi: http://dx.doi.org/10.3126/jnps.v32i2.5494

Cardiovascular aspect of Beta-thalassaemia

Beta-thalassaemia major is a genetic blood disorder caused by the reduced synthesis of beta globin chain. The consequences of the resulting chronic anaemia are also common and include growth retardation, bone marrow expansion, extramedular hematopoiesis, splenomegaly, increased intestinal iron absorption, susceptibility to infections, and hypercoagulability. Transfusional iron overload can affect heart function by directly damaging tissue through iron deposition or via iron-mediated effects at other sites. Cardiac dysfunction is common in patients with thalassaemia and is the leading cause of mortality. The main cardiac abnormalities reported in patients with thalassaemia major (TM) and iron overload are left ventricular systolic and diastolic dysfunction, pulmonary hypertension, valvulopathies, arrhythmias and pericarditis. These cardiac abnormalities are a consequence of the general co-morbid conditions in thalassaemia but are closely related to concomitant endocrine deficiencies, hypercoagulability state and inflammatory milieu. Iron's toxicity within cells arises from its capacity to catalyse the production of reactive oxygen species that cause lipid peroxidation and organelle damage, which lead ultimately to cell death and fibrosis. With the introduction of new technologies such as cardiac magnetic resonance T2* , the early detection of cardiac iron overload and associated cardiac dysfunction is now possible, allowing time for reversal through iron chelation therapy.

Cor triatriatum sinister with situs inversus totalis in an infant

Cor triatriatum sinister is a rare congenital cardiac malformation characterized by a membrane in the left atrium which separates the left atrium into the proximal and distal chambers. Association of cor triatriatum is extremely rare with situs inversus totalis. Here we report a rare case of cor triatriatum sinister with situs inversus totalis in a 5 month old female infant.

Congenital malformations at birth in Central India: A rural medical college hospital based data

OBJECTIVE

To study the incidence of congenital anomalies and the associated risk factors in Department of Pediatrics at Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, a rural medical college hospital in central Maharashtra.

MATERIALS AND METHODS

All the intramural deliveries between 1 January 2005 and 31 July 2007 comprised 9386 births and their 9324 mothers (62 mothers gave birth to twin babies). The newborns were examined and assessed systematically for the presence of congenital anomalies, system wise distribution of anomalies and risk factors attributable.

RESULTS

Out of the total 9386 deliveries, 9194 were live births and 192 were stillbirths. The total number of babies with congenital malformations was 179 (1.91%). Out of the 9262 singleton births, 177 (1.05%) were malformed, whereas 2 of the 62 pairs of twins had birth defects. Nine of the 179 malformed babies (5.02%) were still born. Prematurity, increased maternal age, increasing birth order and low birth weight were found to have a higher risk of congenital anomalies. Cardiovascular malformations were most common in live births, followed by musculoskeletal and genitourinary anomalies.

CONCLUSION

Congenital anomalies are a major cause of stillbirths and infant mortality. Evaluation of cardiovascular system to rule out congenital heart disease in high-risk mothers' babies is the important factor to be considered.

Neonatal genital prolapse

Neonatal genital prolapse is a rare condition, usually associated with congenital spinal defects and is often resistant to simple reduction. A case of complete uterine prolapse which was noted shortly after birth in a female baby with a meningocele at the lumbar region with rectal prolapse is reported. The vagina and uterus was restored to their normal position but came out immediately after reduction.

Unusual presentation of orbital cysticercosis-ptosis, diminution of vision and medial rectus weakness: a case report

Cysticercosis is the most common parasitic disease of the nervous system. The disease occurs when humans become the intermediate host in the life cycle of Taenia solium by ingesting its eggs from contaminated food. The most common sites of involvement of cysticerci are soft tissue, eye and central nervous system. Unusual location of the cysts may result in uncommon manifestations. Ocular cysticercosis can involve both the intraocular and extra ocular muscle. Extra ocular muscle cysticercosis is rare. We are reporting the unusual manifestation of ptosis, proptosis, diminution of vision and medial rectus palsy due to cysticercosis. The patient was successfully treated with systemic steroids and albendazole.