1
|
Munneke AG, Lumens J, Delhaas T. Diagnostic value of reversed differential cyanosis in (supra)cardiac total anomalous pulmonary venous return. Pediatr Res 2024:10.1038/s41390-024-03355-5. [PMID: 38971943 DOI: 10.1038/s41390-024-03355-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 05/13/2024] [Accepted: 06/07/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND To investigate the occurrence of reversed differential cyanosis (RDC) in case of (supra)cardiac total anomalous pulmonary venous return (TAPVR), we explored the hemodynamic changes and oxygen saturation levels during the fetal-to-neonatal transition in (supra)cardiac TAPVR, thereby revealing determinant factors of RDC. METHODS A computational model was used to simulate the cardiovascular fetal-to-neonatal transition up to 24 h after birth. Abnormalities associated with TAPVR, like patent ductus arteriosus (PDA) and persistent pulmonary hypertension of the neonate (PPHN), were imposed on the model. Hemodynamic impact on flow distribution and right-sided pressures as well as oxygen saturations were assessed. RESULTS Model findings demonstrated that RDC in (supra)cardiac TAPVR was dependent on two key factors: (1) the type of pulmonary venous connection being supracardiac or cardiac, and (2) the presence of a patent ductus arteriosus exhibiting right-to-left shunting. Persistence of RDC was mainly determined by the latter; an increase in pulmonary-to-systemic pressure difference by PPHN or PDA-induced pulmonary over-circulation contributed to persistence of RDC. CONCLUSION This study highlights the significance of RDC in (supra)cardiac TAPVR and suggests to incorporate early screening ( < 24 h after birth) and to consider RDC as an immediate fail in screening protocols to ensure prompt detection of (supra)cardiac TAPVR. IMPACT Utilizing a validated computational model for the cardiovascular fetal-to-neonatal transition, this study sheds light on the complex hemodynamics in neonates with (supra)cardiac Total Anomalous Pulmonary Venous Return (TAPVR). Model findings suggest that the often-present pulmonary over-circulation in neonates with TAPVR might significantly contribute to the anomaly's frequent omission during pulse-oximetry screening beyond the first 24 h after birth. This study highlights the diagnostic value of reversed differential cyanosis in early screenings within the first 24 h after birth. By including RDC as an immediate fail in early pulse-oximetry screenings, the likelihood of missing (supra)cardiac TAPVR cases could be reduced.
Collapse
Affiliation(s)
- Anneloes G Munneke
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
| |
Collapse
|
2
|
Stichtenoth G, Gonser M, Hentschel R, Janke E, Maul H, Schmitt A, Steppat S, Werner J, Herting E. Betreuung von Neugeborenen in der Geburtsklinik (Entwicklungsstufe
S2k, AWMF-Leitlinien-Register-Nr. 024–005, März 2021). Z Geburtshilfe Neonatol 2024; 228:137-150. [PMID: 38608666 DOI: 10.1055/a-2195-3995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Affiliation(s)
- Guido Stichtenoth
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - Markus Gonser
- Universitätsspital Zürich, Klinik für Geburtshilfe, Zürich, Schweiz
| | - Roland Hentschel
- Neonatologie/Intensivmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg
| | - Evelin Janke
- Katholische Bildungsstätte für Berufe im Sozial- und Gesundheitswesen GmbH, Akademie St. Franziskus, Lingen (Ems)
| | - Holger Maul
- Geburtshilfe und Pränatalmedizin, Asklepios Klinik Barmbek, Hamburg
| | - Anne Schmitt
- Hochschule für Technik und Wirtschaft des Saarlandes, Saarbrücken
| | | | - Janne Werner
- Florence-Nightingale-Krankenhaus, Kaiserswerther Diakonie, Düsseldorf
| | - Egbert Herting
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| |
Collapse
|
3
|
van Vliet JT, Majani NG, Chillo P, Slieker MG. Diagnostic Accuracy of Physical Examination and Pulse Oximetry for Critical Congenital Cardiac Disease Screening in Newborns. CHILDREN (BASEL, SWITZERLAND) 2023; 11:47. [PMID: 38255361 PMCID: PMC10814555 DOI: 10.3390/children11010047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Newborns with a critical congenital heart disease left undiagnosed and untreated have a substantial risk for serious complications and subsequent failure to thrive. Prenatal ultrasound screening is not widely available, nor is postnatal echocardiography. Physical examination is the standard for postnatal screening. Pulse oximetry has been proposed in numerous studies as an alternative screening method. This systematic review and meta-analysis aims to determine the diagnostic accuracies of both screening methods separately and combined. METHODS A systematic literature search of the Embase, PubMed, and Global Health databases up to 30 November 2023 was conducted with the following keywords: critical congenital heart disease, physical examination, clinical scores, pulse oximetry, and echocardiography. The search included all studies conducted in the newborn period using both physical examination and pulse oximetry as screening methods and excluded newborns admitted to the intensive care unit. All studies were assessed for risk of bias and applicability concerns using the QUADAS-2 score. The review adhered to the PRISMA 2020 statement guideline. RESULTS Out of 2711 articles, 20 articles were selected as eligible for meta-analysis. Cumulatively, the sample included 872,549 screened newborns. The pooled sensitivity of the physical examination screening method was found to be 0.69 (0.66-0.73 (95% CI)) and specificity was found to be 0.98 (0.98-0.98). For the pulse oximetry screening method, the pooled sensitivity and specificity yielded 0.78 (0.75-0.82) and 0.99 (0.99-0.99), respectively. The combined method of screening yielded improved diagnostic characteristics at a sensitivity and specificity of 0.93 (0.91-0.95) and 0.98 (0.98-0.98, respectively. CONCLUSIONS The evidence indicates that combining both physical examination and pulse oximetry to screen for critical congenital heart disease exceeds the accuracy of either separate method. The main limitation is that solely newborns with suspected critical congenital heart disease were subjected to the reference standard. We recommend adapting both methods to screen for critical congenital heart diseases, especially in settings lacking standard fetal ultrasound screening. To increase the sensitivity further, we recommend increasing the screening time window and employing the peripheral perfusion index.
Collapse
Affiliation(s)
- Jari T. van Vliet
- Department of Pediatric Cardiology, Wilhelmina Childrens Hospital, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (J.T.v.V.); (N.G.M.)
| | - Naizihijwa G. Majani
- Department of Pediatric Cardiology, Wilhelmina Childrens Hospital, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (J.T.v.V.); (N.G.M.)
- Department of Pediatric Cardiology, The Jakaya Kikwete Cardiac Institute, Dar es Salaam 65141, Tanzania
| | - Pilly Chillo
- Department of Internal Medicine, School of Medicine, Faculty of Adult Cardiology, Muhimbili Campus, Muhimbili University of Health and Allied Sciences, Dar es Salaam 65001, Tanzania;
| | - Martijn G. Slieker
- Department of Pediatric Cardiology, Wilhelmina Childrens Hospital, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (J.T.v.V.); (N.G.M.)
| |
Collapse
|
4
|
Murni IK, Wibowo T, Arafuri N, Oktaria V, Dinarti LK, Panditatwa D, Patmasari L, Noormanto N, Nugroho S. Feasibility of screening for critical congenital heart disease using pulse oximetry in Indonesia. BMC Pediatr 2022; 22:369. [PMID: 35761296 PMCID: PMC9235153 DOI: 10.1186/s12887-022-03404-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Screening of critical congenital heart disease (CCHD) using pulse oximetry is a routine procedure in many countries, but not in Indonesia. This study aimed to evaluate the feasibility of implementing CCHD screening with pulse oximetry for newborns in Yogyakarta, Indonesia. METHODS A cross-sectional study was conducted at four hospitals in Yogyakarta, Indonesia. Newborns aged 24-48 hours who met the inclusion criteria were screened on the right hand and left or right foot using a pulse oximeter. Positive results were indicated by: either (1) SpO2 level < 90% in one extremity, (2) SpO2 level of 90-94% in both right hand and either foot on three measurements conducted 1 hour apart, or (3) a saturation difference > 3% between the upper and lower extremity on three measurements conducted 1 hour apart. Positive findings were confirmed by echocardiography. RESULTS Of 1452 newborns eligible for screening, 10 had positive results and were referred for echocardiographic evaluation. Of those, 8 (6 per 1000 live birth, 8/1452) had CCHD. Barriers found during screening processes were associated with hospital procedures, equipment, healthcare personnel, and condition of the newborn. CONCLUSION Pulse oximetry screening might be feasible to be implemented within the routine newborn care setting for CCHD in Indonesia. In order to successfully implement pulse oximetry screening to identify CCHD in Indonesia, the barriers will need to be addressed.
Collapse
Affiliation(s)
- Indah K Murni
- Department of Child Health, Dr. Sardjito Hospital/Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
- Center for Child Health-Pediatric Research Office, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Tunjung Wibowo
- Department of Child Health, Dr. Sardjito Hospital/Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Nadya Arafuri
- Department of Child Health, Dr. Sardjito Hospital/Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Vicka Oktaria
- Center for Child Health-Pediatric Research Office, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Biostatistics, Epidemiology and Public Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Lucia K Dinarti
- Department of Cardiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Dicky Panditatwa
- Department of Child Health, Dr. Sardjito Hospital/Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Linda Patmasari
- Department of Child Health, Dr. Sardjito Hospital/Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Noormanto Noormanto
- Department of Child Health, Dr. Sardjito Hospital/Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Sasmito Nugroho
- Department of Child Health, Dr. Sardjito Hospital/Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| |
Collapse
|
5
|
Lutz TL, Raynes-Greenow C, Gordon A. Saturation screening for neonatal hypoxaemia within 6 h of life: Not all about congenital cardiac disease. J Paediatr Child Health 2021; 57:1981-1986. [PMID: 34223680 DOI: 10.1111/jpc.15639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 11/28/2022]
Abstract
AIMS To assess the outcomes of an early oxygen saturation screening programme in apparently healthy newborns for the detection of cardiac and non-cardiac disease. To describe the aetiology and incidence of infants with oxygen saturations <95% in the first 6 h of life and describe the management to discharge. In addition, we sought to identify any risk factors for failed early saturations. METHODS This is a retrospective hospital cohort assessing outcomes of an early saturation screening programme performed in apparently healthy newborns. Infants with oxygen saturations less than 95% were identified and their clinical notes were hand-searched. Descriptive statistics were used to present demographics, proportion of infants who passed or failed screening, subsequent diagnoses and short-term outcome. Multivariate logistic regression was used to identify independent associations of clinical factors (birthweight, gestation, elective caesarean section and gender) with failed screening. RESULTS Between 2014 and 2019, 14 956 healthy newborns were assessed within the first 6 h, 94 (0.63%) failed the early saturation screen. The most common causes for saturation <95% were respiratory disease or delayed transition. There were 31 (33%) infants admitted to the NICU with an additional baby requiring emergency transfer to a cardiac centre. Infants were 28 times more likely to have saturations <95% if born by elective caesarean section (odds ratio 28, conflict of interest (18.54-42.82)). CONCLUSION In apparently healthy newborns, early assessment of oxygen saturation, combined with clinical assessment and subsequent intervention can identify important conditions and should be considered as standard care.
Collapse
Affiliation(s)
- Tracey L Lutz
- Department of Newborn Care, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Camille Raynes-Greenow
- Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Adrienne Gordon
- Department of Newborn Care, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
6
|
Williams KB, Horst M, Hollinger EA, Freedman J, Demczko MM, Chowdhury D. Newborn Pulse Oximetry for Infants Born Out-of-Hospital. Pediatrics 2021; 148:peds.2020-048785. [PMID: 34531289 DOI: 10.1542/peds.2020-048785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Conventional timing of newborn pulse oximetry screening is not ideal for infants born out-of-hospital. We implemented a newborn pulse oximetry screen to align with typical midwifery care and measure its efficacy at detecting critical congenital heart disease. METHODS Cohort study of expectant mothers and infants mainly from the Amish and Mennonite (Plain) communities with limited prenatal ultrasound use. Newborns were screened at 1 to 4 hours of life ("early screen") and 24 to 48 hours of life ("late screen"). Newborns were followed up to 6 weeks after delivery to report outcomes. Early screen, late screen, and combined results were analyzed on the basis of strict algorithm interpretation ("algorithm") and the midwife's interpretation in the field ("field") because these did not correspond in all cases. RESULTS Pulse oximetry screening in 3019 newborns (85% Plain; 50% male; 43% with a prenatal ultrasound) detected critical congenital heart disease in 3 infants. Sensitivity of combined early and late screen was 66.7% (95% confidence interval [CI] 9.4% to 99.2%) for algorithm interpretation and 100% (95% CI 29.2% to 100%) for field interpretation. Positive predictive value was similar for the field interpretation (8.8%; 95% CI 1.9% to 23.7%) and algorithm interpretation (5.4%; 95% CI 0.7% to 18.2%). False-positive rates were ≤1.2% for both algorithm and field interpretations. Other pathologies (noncritical congenital heart disease, pulmonary issues, or infection) were reported in 12 of the false-positive cases. CONCLUSIONS Newborn pulse oximetry can be adapted to the out-of-hospital setting without compromising sensitivity or prohibitively increasing false-positive rates.
Collapse
Affiliation(s)
- Katie B Williams
- Clinic for Special Children, Strasburg, Pennsylvania.,Center for Special Children, Vernon Memorial Healthcare, La Farge, Wisconsin
| | - Michael Horst
- Lancaster General Health Research Institute, Penn Medicine, Lancaster, Pennsylvania
| | - Erika A Hollinger
- Clinic for Special Children, Strasburg, Pennsylvania.,Albright College, Reading, Pennsylvania
| | - Jacob Freedman
- Clinic for Special Children, Strasburg, Pennsylvania.,Franklin & Marshall College, Lancaster, Pennsylvania.,Icahn School of Medicine at Mount Sinai, New York, New York
| | - Matthew M Demczko
- Clinic for Special Children, Strasburg, Pennsylvania.,Divisions of Diagnostic Referral Services
| | - Devyani Chowdhury
- Cardiology Care for Children, Lancaster, Pennsylvania .,Cardiology, Nemours Alfred I. duPont Hospital for Children
| |
Collapse
|
7
|
Withrow E, Fussman C, Thompson K, Kleyn M. Evaluation of Pulse Oximetry Screening Rates Among the Midwife-Attended Out-of-Hospital Birth Community in Michigan. J Midwifery Womens Health 2019; 64:421-426. [PMID: 31347781 DOI: 10.1111/jmwh.12958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/09/2019] [Accepted: 01/12/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In Michigan, pulse oximetry screening rates for critical congenital heart defects (CCHDs) are assessed for birthing hospitals but have not been assessed for the midwife-attended births that occur in the out-of-hospital birth community. This analysis was conducted to determine pulse oximetry screening rates among the midwife-attended out-of-hospital birth community in Michigan overall, and among midwives provided with loaned pulse oximeters from the Michigan Department of Health and Human Services (MDHHS). METHODS Records for midwife-attended out-of-hospital births between April 1, 2014, and December 31, 2016, were linked via probabilistic matching with newborn screening records. Pulse oximetry screening rates were calculated for the midwife-attended out-of-hospital birth population overall, by midwife, and stratified by receipt of loaned pulse oximeters from MDHHS. Births from midwives who attended 5 or more nonhospital births during the study period were included in this analysis. RESULTS Of the 3410 midwife-attended out-of-hospital births, 20.8% (n = 710) reported as having received a pulse oximetry screening for CCHDs. For births attended by midwives who received pulse oximeters from MDHHS, 50.5% had pulse oximetry screening results reported, compared with 12.7% among births attended by midwives without a loaned pulse oximeter. Of the 78 total midwives, 18% (n = 14) reported pulse oximetry screening results on more than half of the births they attended. Of the 14 midwives who received a pulse oximeter from MDHHS, 50.0% (n = 7) reported screening results for more than half of all births they attended. DISCUSSION Our findings indicate that CCHD screening rates are low among midwife-attended out-of-hospital birth community. Screening rates were higher among midwives who received a pulse oximeter from MDHHS, but fewer than half of the attended births had a reported pulse oximetry screening. Further discussions with the midwife-attended out-of-hospital birth community to better understand screening barriers may be beneficial.
Collapse
Affiliation(s)
- Evan Withrow
- Michigan Department of Health and Human Services, Lansing, Michigan
| | - Chris Fussman
- Michigan Department of Health and Human Services, Lansing, Michigan
| | - Kristen Thompson
- Michigan Department of Health and Human Services, Lansing, Michigan
| | - Mary Kleyn
- Michigan Department of Health and Human Services, Lansing, Michigan
| |
Collapse
|
8
|
Ewer AK. Pulse Oximetry Screening for Critical Congenital Heart Defects: A Life-Saving Test for All Newborn Babies. Int J Neonatal Screen 2019; 5:14. [PMID: 33072974 PMCID: PMC7510192 DOI: 10.3390/ijns5010014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/11/2019] [Indexed: 11/16/2022] Open
Abstract
Congenital heart defects (CHD) are the commonest congenital malformations and remain a major cause of neonatal mortality and morbidity in the developed world [...]
Collapse
Affiliation(s)
- Andrew K Ewer
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK;
- Neonatal Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham B15 2TG, UK
| |
Collapse
|
9
|
Narayen IC, te Pas AB, Blom NA, van den Akker-van Marle ME. Cost-effectiveness analysis of pulse oximetry screening for critical congenital heart defects following homebirth and early discharge. Eur J Pediatr 2019; 178:97-103. [PMID: 30334077 PMCID: PMC6311198 DOI: 10.1007/s00431-018-3268-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/07/2018] [Accepted: 10/08/2018] [Indexed: 11/28/2022]
Abstract
Pulse oximetry (PO) screening is used to screen newborns for critical congenital heart defects (CCHD). Analyses performed in hospital settings suggest that PO screening is cost-effective. We assessed the costs and cost-effectiveness of PO screening in the Dutch perinatal care setting, with home births and early postnatal discharge, compared to a situation without PO screening. Data from a prospective accuracy study with 23,959 infants in the Netherlands were combined with a time and motion study and supplemented data. Costs and effects of the situations with and without PO screening were compared for a cohort of 100,000 newborns. Mean screening time per newborn was 4.9 min per measurement and 3.8 min for informing parents. The additional costs of screening were in total €14.71 per screened newborn (€11.00 personnel, €3.71 equipment costs). Total additional costs of screening and referral were €1,670,000 per 100,000 infants. This resulted in an incremental cost-effectiveness ratio of €139,000 per additional newborn with CCHD detected with PO, when compared to a situation without PO screening. A willingness-to-pay threshold of €20,000 per gained QALY for screening in the Netherlands makes the screening likely to be cost-effective.Conclusion: PO screening in the Dutch care setting is likely to be cost-effective. What is Known: • Pulse oximetry is increasingly implemented as a screening tool for critical congenital heart defects in newborns. • Previous studies suggest that the screening in cost-effective and in the USA a reduction in infant mortality from critical congenital heart defects was demonstrated. What is New: • This is the first cost-effectiveness analysis for pulse oximetry screening in a setting with screening after home births, with screening at two moments. • Costs of pulse oximetry screening in a setting with hospital and homebirth deliveries were €14.71 and is likely to be cost-effective accordint to Dutch standards.
Collapse
Affiliation(s)
- Ilona C. Narayen
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Arjan B. te Pas
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nico A. Blom
- Department of Pediatrics, Division of Pediatric Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - M. Elske van den Akker-van Marle
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
10
|
Oddie S, McGuire W. Response to the Letter "RE: Commentary on 'Pulse Oximetry Screening for Critical Congenital Heart Defects'". Neonatology 2019; 116:392. [PMID: 31473740 DOI: 10.1159/000502014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Sam Oddie
- Bradford Neonatology, Bradford Royal Infirmary, Bradford, United Kingdom.,Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - William McGuire
- Centre for Reviews and Dissemination, University of York, York, United Kingdom,
| |
Collapse
|
11
|
Choi EK, Shin JH, Jang GY, Choi BM. Clinical Features of Critical Congenital Heart Disease in Term Infants with Hypoxemia: A Single-Center Study in Korea. NEONATAL MEDICINE 2018. [DOI: 10.5385/nm.2018.25.4.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
12
|
Narayen IC, Blom NA, te Pas AB. Pulse Oximetry Screening Adapted to a System with Home Births: The Dutch Experience. Int J Neonatal Screen 2018; 4:11. [PMID: 33072937 PMCID: PMC7510226 DOI: 10.3390/ijns4020011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 02/11/2018] [Indexed: 11/25/2022] Open
Abstract
Neonatal screening for critical congenital heart defects is proven to be safe, accurate, and cost-effective. The screening has been implemented in many countries across all continents in the world. However, screening for critical congenital heart defects after home births had not been studied widely yet. The Netherlands is known for its unique perinatal care system with a high rate of home births (18%) and early discharge after an uncomplicated delivery in hospital. We report a feasibility, accuracy, and acceptability study performed in the Dutch perinatal care system. Screening newborns for critical congenital heart defects using pulse oximetry is feasible after home births and early discharge, and acceptable to mothers. The accuracy of the test is comparable to other early-screening settings, with a moderate sensitivity and high specificity.
Collapse
Affiliation(s)
- Ilona C. Narayen
- Department of Paediatrics, Division of Neonatology, Leiden University Medical Center, P.O. Box 9200, 2300 RC Leiden, The Netherlands
- Correspondence:
| | - Nico A. Blom
- Division of Paediatric Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Arjan B. te Pas
- Department of Paediatrics, Division of Neonatology, Leiden University Medical Center, P.O. Box 9200, 2300 RC Leiden, The Netherlands
| |
Collapse
|