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Siefkes H, Oliveira LC, Koppel R, Hogan W, Garg M, Manalo E, Cresalia N, Lai Z, Tancredi D, Lakshminrusimha S, Chuah CN. Machine Learning-Based Critical Congenital Heart Disease Screening Using Dual-Site Pulse Oximetry Measurements. J Am Heart Assoc 2024; 13:e033786. [PMID: 38879455 DOI: 10.1161/jaha.123.033786] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/20/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND Oxygen saturation (Spo2) screening has not led to earlier detection of critical congenital heart disease (CCHD). Adding pulse oximetry features (ie, perfusion data and radiofemoral pulse delay) may improve CCHD detection, especially coarctation of the aorta (CoA). We developed and tested a machine learning (ML) pulse oximetry algorithm to enhance CCHD detection. METHODS AND RESULTS Six sites prospectively enrolled newborns with and without CCHD and recorded simultaneous pre- and postductal pulse oximetry. We focused on models at 1 versus 2 time points and with/without pulse delay for our ML algorithms. The sensitivity, specificity, and area under the receiver operating characteristic curve were compared between the Spo2-alone and ML algorithms. A total of 523 newborns were enrolled (no CHD, 317; CHD, 74; CCHD, 132, of whom 21 had isolated CoA). When applying the Spo2-alone algorithm to all patients, 26.2% of CCHD would be missed. We narrowed the sample to patients with both 2 time point measurements and pulse-delay data (no CHD, 65; CCHD, 14) to compare ML performance. Among these patients, sensitivity for CCHD detection increased with both the addition of pulse delay and a second time point. All ML models had 100% specificity. With a 2-time-points+pulse-delay model, CCHD sensitivity increased to 92.86% (P=0.25) compared with Spo2 alone (71.43%), and CoA increased to 66.67% (P=0.5) from 0. The area under the receiver operating characteristic curve for CCHD and CoA detection significantly improved (0.96 versus 0.83 for CCHD, 0.83 versus 0.48 for CoA; both P=0.03) using the 2-time-points+pulse-delay model compared with Spo2 alone. CONCLUSIONS ML pulse oximetry that combines oxygenation, perfusion data, and pulse delay at 2 time points may improve detection of CCHD and CoA within 48 hours after birth. REGISTRATION URL: https://www.clinicaltrials.gov/study/NCT04056104?term=NCT04056104&rank=1; Unique identifier: NCT04056104.
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Affiliation(s)
| | - Luca Cerny Oliveira
- Department of Electrical & Computer Engineering University of California Davis CA
| | - Robert Koppel
- Department of Pediatrics, Cohen Children's Medical Center Zucker School of Medicine at Hofstra/Northwell New Hyde Park NY
| | - Whitnee Hogan
- University of Utah, Primary Children's Hospital Salt Lake City UT
| | - Meena Garg
- Department of Pediatrics University of California Los Angeles CA
| | - Erlinda Manalo
- Department of Pediatrics Sutter Sacramento Medical Center Sacramento CA
| | - Nicole Cresalia
- Department of Pediatrics University of California San Francisco CA
| | - Zhengfeng Lai
- Department of Electrical & Computer Engineering University of California Davis CA
| | | | | | - Chen-Nee Chuah
- Department of Electrical & Computer Engineering University of California Davis CA
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Sharma M, Brown AW, Powell NM, Rajaram N, Tong L, Mourani PM, Schootman M. Racial and skin color mediated disparities in pulse oximetry in infants and young children. Paediatr Respir Rev 2024; 50:62-72. [PMID: 38233229 PMCID: PMC11139570 DOI: 10.1016/j.prrv.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024]
Abstract
Race-based and skin pigmentation-related inaccuracies in pulse oximetry have recently been highlighted in several large electronic health record-based retrospective cohort studies across diverse patient populations and healthcare settings. Overestimation of oxygen saturation by pulse oximeters, particularly in hypoxic states, is disparately higher in Black compared to other racial groups. Compared to adult literature, pediatric studies are relatively few and mostly reliant on birth certificates or maternal race-based classification of comparison groups. Neonates, infants, and young children are particularly susceptible to the adverse life-long consequences of hypoxia and hyperoxia. Successful neonatal resuscitation, precise monitoring of preterm and term neonates with predominantly lung pathology, screening for congenital heart defects, and critical decisions on home oxygen, ventilator support and medication therapies, are only a few examples of situations that are highly reliant on the accuracy of pulse oximetry. Undetected hypoxia, especially if systematically different in certain racial groups may delay appropriate therapies and may further perpetuate health care disparities. The role of biological factors that may differ between racial groups, particularly skin pigmentation that may contribute to biased pulse oximeter readings needs further evaluation. Developmental and maturational changes in skin physiology and pigmentation, and its interaction with the operating principles of pulse oximetry need further study. Importantly, clinicians should recognize the limitations of pulse oximetry and use additional objective measures of oxygenation (like co-oximetry measured arterial oxygen saturation) where hypoxia is a concern.
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Affiliation(s)
- Megha Sharma
- Department of Pediatrics, Division of Neonatology, University of Arkansas for Medical Sciences, Little Rock, AR, United States; Arkansas Children's Research Institute, Little Rock, AR, United States.
| | - Andrew W Brown
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, United States; Arkansas Children's Research Institute, Little Rock, AR, United States
| | - Nicholas M Powell
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, United States
| | - Narasimhan Rajaram
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, United States; Winthrop P. Rockefeller Cancer Institute, Little Rock, AR, United States
| | - Lauren Tong
- Clinical Library Services, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Peter M Mourani
- Arkansas Children's Research Institute, Little Rock, AR, United States; Department of Pediatrics, Division of Pediatric Critical Care, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Mario Schootman
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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Rasmussen M, Suttner D, Poeltler D, Katheria AC. Use of Pulse Oximetry Pulsatility Index Screening for Critical Congenital Heart Disease. Am J Perinatol 2024; 41:e545-e549. [PMID: 35858650 DOI: 10.1055/a-1904-9389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This study aimed to compare oximetry data (pre- and postductal oxygen saturation [SpO2], pre- and postductal pulsatility index [PI]) in healthy newborns (≥35 weeks' gestational age) to infants who have critical congenital heart disease (CCHD). STUDY DESIGN This is a retrospective analysis of data obtained from electronic medical records, recorded as part of routine pulse oximetry screening (POS) for CCHD in infants born between the years 2013 and 2020. Testing was performed at 24 ± 2 hours of life. Data were analyzed to detect differences in pre- and postductal SpO2 and pre- and postductal PI in healthy newborns compared with infants who have CCHD. Newborns were excluded from analysis if they: (1) had a prenatal diagnosis of CCHD in the medical record, (2) had previously been admitted to the neonatal intensive care unit, or (3) had failed POS but were found no CCHD by diagnostic echocardiography. RESULTS A total of 88,754 healthy newborns had received POS between the years 2013 and 2020. Of the 88,736 newborn records available for analysis,18 newborns were diagnosed with CCHD. Eight were identified by POS before discharge and 10 were diagnosed after discharge. Infants diagnosed with CCHD by POS had lower pre- and postductal SpO2 compared with normal infants. Their postductal PI was significantly lower. Infants who had CCHD that was not identified by POS had similar pre- and postductal SpO2 values, but their postductal PI was lower. Using a postductal PI cutoff of 1.21 had a receiver operating curve of area under the curve 0.77 (95% confidence interval: 0.672, 0.869) with 74% sensitivity and 61% specificity. CONCLUSION In our large cohort of infants born in San Diego County, the postductal PI is lower in infants with CCHD. Given that PI is routinely displayed on every pulse oximeter and the high morbidity of missed CCHD, PI should be incorporated into routine CCHD screening. KEY POINTS · Postductal PI is lower in newborn who presented later with congenital heart disease.. · Postductal PI cut-off of 1.21 may help practitioners determine if a newborn is at risk for CCHD.. · This large cohort study demonstrates that a low PI can detect additional CCHD cases..
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Affiliation(s)
- Maynard Rasmussen
- Department of Pediatrics, Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
| | - Denise Suttner
- Division of Neonatology, Rady Children's Hospital, San Diego, California
- Department of Pediatrics, University of California, San Diego, La Jolla, San Diego, California
| | - Debra Poeltler
- Department of Pediatrics, Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
| | - Anup C Katheria
- Department of Pediatrics, Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
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Bravo-Jaimes K, Vasquez-Loarte T, Rojas-Camayo J, Medina M, Mejia CR, Zapata-Galarza H, Berrocal M, Orozco J, Lozano D, Santivañez M, Sangay C, Rosales W, Mamani L, Macedo N, Coronado J, Huaman G, Marquez R, Li Z, Masood KM, Alejos J, Reardon L, Lin J. A new algorithm DEtectS critical Congenital Heart Disease at different altitudes: ANDES-CHD study. J Perinatol 2024; 44:373-378. [PMID: 38308011 DOI: 10.1038/s41372-024-01888-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Neonatal pulse oximetry screening (POS) algorithms for critical congenital heart disease (CCHD) have contributed towards decreasing neonatal mortality but cannot be applied at high altitudes. New POS algorithms at high altitudes are needed. METHODS This observational, prospective study included newborns born at different altitudes from 0 to 4380 meters above the sea level in Peru. Healthy newborns underwent neonatal preductal and postductal oximetry, echocardiography and telephonic follow-up up to 12 months of age. Newborns with CCHD underwent preductal and postductal oximetry at the time of telemedicine evaluation while located at the high-altitude hospital where they were born, and their diagnoses were confirmed with echocardiography locally or after arriving to the referral center. Two new algorithms were designed using clinically accepted neonatal oximetry cutoffs or the 5th and 10th percentiles for preductal and postductal oximetry values. RESULTS A total of 502 healthy newborns and 15 newborns with CCHD were enrolled. Echocardiography and telephonic follow-up were completed in 227 (45%) and 330 healthy newborns (65%), respectively. The algorithm based on clinically accepted cutoffs had a sensitivity of 92%, specificity of 73% and false positive rate of 27% The algorithm based on the 5th and 10th percentiles had a sensitivity of 80%, specificity of 88% and false positive rate of 12%. CONCLUSIONS Two algorithms that detect CCHD at different altitudes had adequate performance but high false positive rates.
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Affiliation(s)
- Katia Bravo-Jaimes
- Department of Cardiovascular Medicine. Mayo Clinic, Jacksonville, FL, USA.
| | | | | | - Monica Medina
- Instituto Nacional de Salud del Niño de San Borja, Lima, Peru
| | | | | | | | | | | | | | | | | | | | | | - Joel Coronado
- Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Gian Huaman
- Instituto Nacional Cardiovascular, Lima, Peru
| | | | - Zhuo Li
- Department of Cardiovascular Medicine. Mayo Clinic, Jacksonville, FL, USA
| | - Kiran M Masood
- Department of Pediatrics, University of California, Los Angeles, CA, USA
| | - Juan Alejos
- Department of Pediatrics, Mattel Children´s Hospital, California, CA, USA
| | - Leigh Reardon
- Department of Pediatrics, Mattel Children´s Hospital, California, CA, USA
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, CA, USA
| | - Jeannette Lin
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, CA, USA
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Girdhar A, Ewer AK. Pulse Oximetry Screening for Critical Congenital Heart Defects in Newborn Babies. Crit Care Nurs Clin North Am 2024; 36:99-110. [PMID: 38296378 DOI: 10.1016/j.cnc.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Pulse oximetry screening (POS) was first described over 20 years ago. However, in recent years, major clinical trials have demonstrated consistent test accuracy for the detection of critical congenital heart defects (CCHD). International uptake of POS has progressed well over the last 10 years with most major high-income countries now recommending screening. This review describes the evidence base which has led to this, the current debate regarding choice of screening algorithm, and the future areas for further research.
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Affiliation(s)
- Anurag Girdhar
- Department of Neonatology, Birmingham Women's Hospital NHS Trust, Birmingham, United Kingdom
| | - Andrew K Ewer
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Saganski GF, Freire MHDS, dos Santos WM. Pulse oximetry test for screening congenital heart diseases: a systematic review. Rev Esc Enferm USP 2024; 57:e20230215. [PMID: 38426937 PMCID: PMC10906467 DOI: 10.1590/1980-220x-reeusp-2023-0215en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/06/2023] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE To determine the accuracy of the Pulse Oximetry Test (POT) in screening for Congenital Heart Diseases (CHD) in newborns in the first 48 hours of life. METHOD Systematic review of diagnostic test accuracy with meta-analysis. The selection of studies was carried out in June 2021. Studies were selected with newborns, in a hospital or home environment, without a previous diagnosis of CHD, regardless of gestational age at birth, who underwent POT within the first 48 hours after birth. Registration on the PROSPERO platform - CRD42021256286. RESULTS Twenty-nine studies were included, totaling a population of 388,491 newborns. POT demonstrated sensitivity of 47% (95% CI: 43% to 50%) and specificity of 98% (95% CI: 98% to 98%). Subgroup analyses were carried out according to the different testing period, inclusion of retests in protocols and population of premature newborns. CONCLUSION POT is a test with moderate sensitivity and high specificity. It is more effective when carried out within 24h - 48h of birth; in protocols that present retests, within two hours after the first measurement. It does not show satisfactory effectiveness for premature newborns.
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Affiliation(s)
| | - Márcia Helena de Souza Freire
- Universidade Federal do Paraná, Departamento de Enfermagem, Curitiba, PR, Brazil
- Instituto Joanna Briggs. São Paulo, SP, Brazil
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Dilli D, Akduman H, Zenciroğlu A, Çetinkaya M, Okur N, Turan Ö, Özlü F, Çalkavur Ş, Demirel G, Koksal N, Çolak R, Örün UA, Öztürk E, Gül Ö, Tokel NK, Erdem S, Meşe T, Erdem A, Bostan ÖM, Polat TB, Taşar M, Hatemi AC, Doyurgan O, Özkan M, Avşar MK, Sarıosmanoğlu ON, Uğurlucan M, Sığnak IŞ, Başaran M. Neonatal Outcomes of Critical Congenital Heart Defects: A Multicenter Epidemiological Study of Turkish Neonatal Society : Neonatal Outcomes of CCHD. Pediatr Cardiol 2024; 45:257-271. [PMID: 38153547 DOI: 10.1007/s00246-023-03362-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/20/2023] [Indexed: 12/29/2023]
Abstract
Critical congenital heart disease (CCHD) is one of the leading causes of neonatal and infant mortality. We aimed to elucidate the epidemiology, spectrum, and outcome of neonatal CCHD in Türkiye. This was a multicenter epidemiological study of neonates with CCHD conducted from October 2021 to November 2022 at national tertiary health centers. Data from 488 neonatal CCHD patients from nine centers were entered into the Trials-Network online registry system during the study period. Transposition of great arteria was the most common neonatal CHD, accounting for 19.5% of all cases. Sixty-three (12.9%) patients had extra-cardiac congenital anomalies. A total of 325 patients underwent cardiac surgery. Aortic arch repair (29.5%), arterial switch (25.5%), and modified Blalock-Taussig shunt (13.2%). Overall, in-hospital mortality was 20.1% with postoperative mortality of 19.6%. Multivariate analysis showed that the need of prostaglandin E1 before intervention, higher VIS (> 17.5), the presence of major postoperative complications, and the need for early postoperative extracorporeal membrane oxygenation were the main risk factors for mortality. The mortality rate of CCHD in our country remains high, although it varies by health center. Further research needs to be conducted to determine long-term outcomes for this vulnerable population.
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Affiliation(s)
- Dilek Dilli
- Department of Neonatology, Dr. Sami Ulus Research and Application Center, Health Science University of Turkey, Ankara, Turkey.
| | - Hasan Akduman
- Department of Neonatology, Dr. Sami Ulus Research and Application Center, Health Science University of Turkey, Ankara, Turkey
| | - Ayşegül Zenciroğlu
- Department of Neonatology, Dr. Sami Ulus Research and Application Center, Health Science University of Turkey, Ankara, Turkey
| | - Merih Çetinkaya
- Department of Neonatology, Başakşehir Çam Sakura City Hospital, Health Science University of Turkey, İstanbul, Turkey
| | - Nilüfer Okur
- Department of Neonatology, Gazi Yaşargil Research and Application Center, Health Science University of Turkey, Diyarbakır, Turkey
| | - Özden Turan
- Department of Neonatology, Başkent University, Medical Faculty, Ankara, Turkey
| | - Ferda Özlü
- Department of Neonatology, Çukurova University, Medical Faculty, Adana, Turkey
| | - Şebnem Çalkavur
- Department of Neonatology, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Health Science University of Turkey, İzmir, Turkey
| | - Gamze Demirel
- Department of Neonatology, İstanbul Medipol University, International Faculty of Medicine, Istanbul, Turkey
| | - Nilgün Koksal
- Department of Neonatology, Uludağ University, Medical Faculty, Bursa, Turkey
| | - Rüya Çolak
- Department of Neonatology, Beykent University Medical Faculty, Istanbul, Turkey
| | - Utku Arman Örün
- Department of Pediatric Cardiology, Dr. Sami Ulus Research and Application Center, Health Science University of Turkey, Ankara, Turkey
| | - Erkut Öztürk
- Department of Pediatric Cardiology, Başakşehir Çam Sakura City Hospital, Health Science University of Turkey, Istanbul, Turkey
| | - Özlem Gül
- Department of Pediatric Cardiology, Gazi Yaşargil Research and Application Center, Health Science University of Turkey, Diyarbakır, Turkey
| | - Niyazi Kürşad Tokel
- Department of Pediatric Cardiology, Başkent University, Medical Faculty, Ankara, Turkey
| | - Sevcan Erdem
- Department of Pediatric Cardiology, Çukurova University, Medical Faculty, Adana, Turkey
| | - Timur Meşe
- Department of Pediatric Cardiology, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Health Science University of Turkey, İzmir, Turkey
| | - Abdullah Erdem
- Department of Pediatric Cardiology, İstanbul Medipol University, International Faculty of Medicine, İstanbul, Turkey
| | - Özlem Mehtap Bostan
- Department of Pediatric Cardiology, Uludağ University, Medical Faculty, Bursa, Turkey
| | - Tuğçin Bora Polat
- Department of Pediatric Cardiology, Beykent University, Medical Faculty, İstanbul, Turkey
| | - Mehmet Taşar
- Department of Pediatric Cardiovascular Surgery, Dr. Sami Ulus Research and Application Center, Health Science University of Turkey, Ankara, Turkey
| | - Ali Can Hatemi
- Department of Pediatric Cardiovascular Surgery, Başakşehir Çam Sakura City Hospital, Health Science University of Turkey, İstanbul, Turkey
| | - Onur Doyurgan
- Department of Pediatric Cardiovascular Surgery, Gazi Yaşargil Research and Application Center, Health Science University of Turkey, Diyarbakır, Turkey
| | - Murat Özkan
- Department of Pediatric Cardiovascular Surgery, Başkent University, Medical Faculty, Ankara, Turkey
| | - Mustafa Kemal Avşar
- Department of Pediatric Cardiovascular Surgery, Çukurova University, Medical Faculty, Adana, Turkey
| | - Osman Nejat Sarıosmanoğlu
- Department of Pediatric Cardiovascular Surgery, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Health Science University of Turkey, İzmir, Turkey
| | - Murat Uğurlucan
- Department of Pediatric Cardiovascular Surgery, İstanbul Medipol University, International Faculty of Medicine, İstanbul, Turkey
| | - Işık Şenkaya Sığnak
- Department of Pediatric Cardiovascular Surgery, Uludağ University, Medical Faculty, Bursa, Turkey
| | - Murat Başaran
- Department of Pediatric Cardiovascular Surgery, Beykent University, Medical Faculty, Istanbul, Turkey
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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.
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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.)
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Taha S, Simpson RB, Sharkey D. The critical role of technologies in neonatal care. Early Hum Dev 2023; 187:105898. [PMID: 37944264 DOI: 10.1016/j.earlhumdev.2023.105898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
Neonatal care has made significant advances in the last few decades. As a result, mortality and morbidity in high-risk infants, such as extremely preterm infants or those infants with birth-related brain injury, has reduced significantly. Many of these advances have been facilitated or delivered through development of medical technologies allowing clinical teams to be better supported with the care they deliver or provide new therapies and diagnostics to improve management. The delivery of neonatal intensive care requires the provision of medical technologies that are easy to use, reliable, accurate and ideally developed for the unique needs of the newborn population. Many technologies have been developed and commercialised following adult trials without ever being studied in neonatal patients despite the unique characteristics of this population. Increasingly, funders and industry are recognising this major challenge which has resulted in initiatives to develop new ideas from concept through to clinical care. This review explores some of the key medical technologies used in neonatal care and the evidence to support their adoption to improve outcomes. A number of devices have yet to realise their full potential and will require further development to optimise and find their ideal target population and clinical benefit. Examples of emerging technologies, which may soon become more widely used, are also discussed. As neonatal care relies more on medical technologies, we need to be aware of the impact on care pathways, especially from a human factors approach, the associated costs and subsequent benefits to patients alongside the supporting evidence.
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Affiliation(s)
- Syed Taha
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - Rosalind B Simpson
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - Don Sharkey
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom.
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Jiang SL, Zhan YJ, Yan P, Yue Y, Tang J. Pulse Oximetry and Perfusion Index Screening for Congenital Heart Defects: A Systematic Review and Meta-analysis. Am J Perinatol 2023; 40:1611-1617. [PMID: 35580627 DOI: 10.1055/s-0042-1748163] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Congenital heart defects (CHDs) are the most common neonatal malformations and are a leading cause of infant death in developed countries. Finding safe and effective diagnostic methods to screen for CHDs is important. The aim of this study was to evaluate the effectiveness of pulse oximetry (PO) and perfusion index (PI) in screening CHD. We conducted a systematic review of studies in PubMed, Embase, and the Cochrane Library published on or before October 1, 2021. Studies based on PICOS were included in this systematic review. The flow chart is made by PRISMA software. The quality of included studies was assessed by RevMan5 software (QUADAS-2: Quality Assessment of Diagnostic Accuracy Studies-2). The sensitivity, specificity, and other measurements of accuracy were pooled using Stata/SE 12.0 software. Five studies containing 46,965 neonates were included in this study. A randomized-effects model was used for the meta-analysis because of significant heterogeneity. The combined sensitivity and specificity were 0.82 (95% confidence interval [CI], 0.53-0.95) and 0.97 (95% CI, 0.57-1.00), respectively. The area under the curve was 0.92 (95% CI, 0.89-0.94). The combination PO and PI was significant in CHD screening. Once diagnosed by the combined method, it means that the neonate is most likely to have a CHD. KEY POINTS: · Pulse oximetry and PI screening.. · Congenital heart defects.. · A systematic review and meta-analysis..
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Affiliation(s)
- S L Jiang
- Department of Pediatrics, West China Second University Hospital, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, People's Republic of China
| | - Y J Zhan
- Department of Pediatrics, West China Second University Hospital, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, People's Republic of China
| | - P Yan
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Wu Hou District, Chengdu, Sichuan, People's Republic of China
| | - Y Yue
- Department of Pediatrics, West China Second University Hospital, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, People's Republic of China
| | - J Tang
- Department of Pediatrics, West China Second University Hospital, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, People's Republic of China
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Lannering K, Kazamia K, Bergman G, Östman-Smith I, Liuba P, Dahlqvist JA, Elfvin A, Mellander M. Screening for Critical Congenital Heart Defects in Sweden. Pediatrics 2023; 152:e2023061949. [PMID: 37732389 DOI: 10.1542/peds.2023-061949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVES Early diagnosis of critical congenital heart defects (CCHD) improves survival. We evaluated the relative contributions of prenatal ultrasound, neonatal pulse oximetry screening (POS), and neonatal physical examination (NPE) to the early detection (before discharge) of CCHD in the context of increasing prenatal detection, and POS being a national standard since 2013. METHODS Retrospective, nationwide population-based study. All full-term live-born infants with CCHD in Sweden between 2014 and 2019 were included. CCHD was defined as a congenital heart defect requiring surgery or catheter-based intervention or resulting in death within 28 days of birth. RESULTS Of 630 infants, 89% were diagnosed before discharge or death, 42% prenatally, 11% from early symptoms, 23% by POS, and 14% from NPE after a negative POS. Four (0.6%) died undiagnosed before discharge and 64/630 (10%) were discharged undiagnosed, with 24/64 being readmitted with circulatory failure and causing 1 preoperative death. Coarctation was the most prevalent CCHD (N = 184), 25% of whom were detected prenatally (12% by POS and 29% by NPE). Two died undiagnosed before discharge and 30% were discharged undiagnosed. Transposition was the second most common defect (N = 150) and 43% were detected prenatally (33% by POS, 1 by NPE) and 2 died undiagnosed before POS. None was discharged undiagnosed. CONCLUSIONS POS and NPE remain important for the early detection of CCHD complementing prenatal ultrasound screening. Nevertheless, 1 in 10 with CCHD leaves the hospital without a diagnosis, with coarctation being the predominant lesion. Future research on CCHD screening should have a particular focus on this cardiac defect.
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Affiliation(s)
- Katarina Lannering
- Region Västra Götaland, Children's Heart Center, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Pediatrics, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Kalliopi Kazamia
- Department of Pediatric Cardiology, Stockholm-Uppsala, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Gunnar Bergman
- Department of Pediatric Cardiology, Stockholm-Uppsala, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Ingegerd Östman-Smith
- Department of Pediatrics, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Petru Liuba
- Department of Cardiology, Pediatric Heart Center, Skåne University Hospital Lund, Lund University, Lund, Sweden
| | | | - Anders Elfvin
- Department of Pediatrics, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Department of Pediatrics, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mats Mellander
- Region Västra Götaland, Children's Heart Center, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Pediatrics, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
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Hasan AA, Abu Lehyah NAA, Al Tarawneh MK, Abbad MY, Fraijat AG, Al-Jammal RA, Moamar DM, Shersheer QA, Guthrie SO, Starnes JR. Incidence and types of congenital heart disease at a referral hospital in Jordan: retrospective study from a tertiary center. Front Pediatr 2023; 11:1261130. [PMID: 37780050 PMCID: PMC10540778 DOI: 10.3389/fped.2023.1261130] [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: 07/18/2023] [Accepted: 09/05/2023] [Indexed: 10/03/2023] Open
Abstract
Background Congenital heart disease (CHD) is the most common birth defect and accounts for significant global morbidity and mortality. Relatively little is known about the epidemiology of CHD in Jordan or the manner in which CHD is identified. Methods A retrospective medical record review was conducted for all neonates who had an abnormal echocardiogram performed at a tertiary referral hospital. All included neonates had echocardiography performed by the same pediatric cardiologist at the discretion of the treatment team. Descriptive statistics were used to describe CHD incidence, types of CHD identified, and mechanism of identification. Results The incidence of congenital heart disease was 17.8 per 1,000 live births. This rose to 24.6 per 1,000 if patent ductus arteriosus in preterm infants was included. The most common identified abnormalities were PDA, atrial septal defects, persistent pulmonary hypertension, septal hypertrophy, and ventricular septal defects. Most children were evaluated either for a murmur heard on exam or as a part of screening due to other comorbidities or risk factors. Less than 1% of children had a prenatal diagnosis. There was a higher rate of persistent pulmonary hypertension during the COVID-19 pandemic than before (p < 0.001). Conclusions There is a high incidence of CHD in Jordan. Increased prenatal and perinatal screening for CHD may allow for earlier detection.
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Affiliation(s)
- Abeer A. Hasan
- Division of Neonatology, Department of Pediatrics, Maternity and Children’s Hospital at Al Bashir Hospital, Amman, Jordan
| | - Naser Aldain A. Abu Lehyah
- Division of Neonatology, Department of Pediatrics, Maternity and Children’s Hospital at Al Bashir Hospital, Amman, Jordan
| | - Moath K. Al Tarawneh
- Department of General Pediatrics, Maternity and Children’s Hospital at Al Bashir Hospital, Amman, Jordan
| | - Mahmoud Y. Abbad
- Department of General Pediatrics, Maternity and Children’s Hospital at Al Bashir Hospital, Amman, Jordan
| | - Areen G. Fraijat
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Maternity and Children’s Hospital at Al Bashir Hospital, Amman, Jordan
| | - Razan A. Al-Jammal
- Division of Neonatology, Department of Pediatrics, Maternity and Children’s Hospital at Al Bashir Hospital, Amman, Jordan
| | - Dania M. Moamar
- Department of Obstetrics and Gynaecology, Maternity and Children’s Hospital at Al Bashir Hospital, Amman, Jordan
| | - Qasem A. Shersheer
- Department of General Pediatrics, Maternity and Children’s Hospital at Al Bashir Hospital, Amman, Jordan
| | - Scott O. Guthrie
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Joseph R. Starnes
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
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Rabiço-Costa D, Leite-Almeida L, Geraldes Paulino S, Santos N, Gomes AC, Rocha G. Heart Disease Screening and False Hypoxemia in the Neonate. Fetal Pediatr Pathol 2023; 42:614-618. [PMID: 36999658 DOI: 10.1080/15513815.2023.2195498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Screening for congenital heart diseases by pulse oximetry is used for the initial assessment of the neonate. Variants of hemoglobin F can compromise light absorbance, inducing erroneous results. CASE REPORT Two infants screened for congenital heart disease showed an asymptomatic low peripheral oxygen saturation. Arterial blood gases analysis revealed a normal arterial pressure of oxygen and oxygen saturation. More likely and/or severe causes of hypoxemia were ruled out. This "artifact" with SpO2-SaO2 dissociation, and after exclusion of other common etiologies of hypoxemia, raised the clinical suspicion of hemoglobinopathy. Hemoglobin molecular and genetic studies identified specific mutations in gamma chains from hemoglobin F, named hemoglobin F Sardinia. CONCLUSION Hemoglobin F variants may result in low peripheral oxygen saturation readings by pulse oximetry, explaining the discordance in the clinical appearance and low peripheral oxygen saturation readings.
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Affiliation(s)
- David Rabiço-Costa
- Pediatric Department, São João University Hospital Center, Porto, Portugal
| | | | | | - Nuno Santos
- Pediatric Department, Lusíadas Hospital, Porto, Portugal
| | - Ana Cristina Gomes
- Pediatric Department, São João University Hospital Center, Porto, Portugal
- Neonatology Section, Pediatric Department, São João University Hospital Center, Porto, Portugal
| | - Gustavo Rocha
- Pediatric Department, São João University Hospital Center, Porto, Portugal
- Neonatology Section, Pediatric Department, São João University Hospital Center, Porto, Portugal
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Ma X, Tian Y, Ma F, Ge X, Gu Q, Huang M, Zhang Y, Sun K, Hu X, Yang M, Jia P, Liu F, Zhao Q, Yan W, Peng Y, Huang G. Impact of Newborn Screening Programme for Congenital Heart Disease in Shanghai: a five-year observational study in 801,831 newborns. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 33:100688. [PMID: 37181527 PMCID: PMC10166988 DOI: 10.1016/j.lanwpc.2023.100688] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/15/2022] [Accepted: 12/25/2022] [Indexed: 01/28/2023]
Abstract
Background Newborn Screening Programme for Congenital Heart Disease (CHD) in Shanghai has been in operation for over 5 years, and its feasibility and effectiveness still lack a systematic and comprehensive evaluation. This study aimed to detail the implementation of the programme and evaluate its results, benefits, and reliability in clinical practice. Methods This study was an observational study involving all newborns received CHD screening in Shanghai from 2017 to 2021. Pulse oximetry (POX) plus cardiac murmur auscultation (namely the dual-index method) was used for CHD screening in newborns aged 6-72 h. Newborns who screened positive was recommended for echocardiography, and those diagnosed with CHD would be planned for further evaluation and intervention. Data were aggregated by birth year and district of birth. Results of neonatal CHD screening, diagnosis and treatment, and temporal trends of infant mortality rate (IMR) and the proportion of under-five mortality (U5M) attributed to CHD were analysed. A retrospective cohort study was also conducted to assess the reliability of the dual-index method in clinical practice. Findings In total, 801,831 (99.48%) newborns were screened for CHD, 16,489 (2.06%) were screened positive, and 3541 (21.47%) of the screened-positive newborns were identified with CHD. Seven hundred and fifty-two patients with CHD received surgical or interventional treatment with a successful rate of 94.81%. The period from 2015 to 2021 witnessed an approximately twofold decrease in IMR from 4.58‰ to 2.30‰, and a downtrend in the proportion of U5M attributed to CHD from 25.93% to 16.61%. High sensitivity and specificity of the dual-index method in clinical practice were observed for both critical (100.00% and 97.72%) and major CHD (98.47% and 97.76%). Interpretation Newborn screening programme for CHD has been well implemented in Shanghai, and this programme is a successful public health intervention to reduce infant death. Our study provides encouraging evidence and experience for implementing newborn screening programme for CHD nationwide in China. Funding This study was supported by the National Key Research and Development Programme of China (2021YFC2701004 and 2016YFC1000506), CAMS Innovation Fund for Medical Sciences (2019-I2M-5-002), and Three-Year Planning for Strengthening the Construction of Public Health System in Shanghai (No. GWIV-24).
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Affiliation(s)
- Xiaojing Ma
- National Management Office of Neonatal Screening Project for CHD, Children's Hospital of Fudan University, National Children's Medical Centre, Shanghai, China
- Paediatric Heart Centre, Children's Hospital of Fudan University, National Children's Medical Centre, Shanghai, China
- Shanghai Key Laboratory of Birth Defects, Shanghai, China
- Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China
| | - Youping Tian
- National Management Office of Neonatal Screening Project for CHD, Children's Hospital of Fudan University, National Children's Medical Centre, Shanghai, China
| | - Fuchan Ma
- Department of Child Healthcare, Shanghai Centre for Women and Children Health, Shanghai, China
| | - Xiaoling Ge
- National Management Office of Neonatal Screening Project for CHD, Children's Hospital of Fudan University, National Children's Medical Centre, Shanghai, China
| | - Qing Gu
- National Management Office of Neonatal Screening Project for CHD, Children's Hospital of Fudan University, National Children's Medical Centre, Shanghai, China
- Paediatric Heart Centre, Children's Hospital of Fudan University, National Children's Medical Centre, Shanghai, China
| | - Min Huang
- Department of Cardiology, Shanghai Children's Hospital, Shanghai, China
| | - Yuqi Zhang
- Heart Center, Shanghai Children's Medical Centre Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kun Sun
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaojing Hu
- National Management Office of Neonatal Screening Project for CHD, Children's Hospital of Fudan University, National Children's Medical Centre, Shanghai, China
| | - Miao Yang
- National Management Office of Neonatal Screening Project for CHD, Children's Hospital of Fudan University, National Children's Medical Centre, Shanghai, China
| | - Pin Jia
- National Management Office of Neonatal Screening Project for CHD, Children's Hospital of Fudan University, National Children's Medical Centre, Shanghai, China
| | - Fang Liu
- Paediatric Heart Centre, Children's Hospital of Fudan University, National Children's Medical Centre, Shanghai, China
- Shanghai Key Laboratory of Birth Defects, Shanghai, China
- Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China
| | - Quming Zhao
- Paediatric Heart Centre, Children's Hospital of Fudan University, National Children's Medical Centre, Shanghai, China
| | - Weili Yan
- National Management Office of Neonatal Screening Project for CHD, Children's Hospital of Fudan University, National Children's Medical Centre, Shanghai, China
- Shanghai Key Laboratory of Birth Defects, Shanghai, China
- Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China
| | - Yongmei Peng
- Department of Child Healthcare, Shanghai Centre for Women and Children Health, Shanghai, China
| | - Guoying Huang
- National Management Office of Neonatal Screening Project for CHD, Children's Hospital of Fudan University, National Children's Medical Centre, Shanghai, China
- Paediatric Heart Centre, Children's Hospital of Fudan University, National Children's Medical Centre, Shanghai, China
- Shanghai Key Laboratory of Birth Defects, Shanghai, China
- Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China
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Nardini S, Corbanese U, Visconti A, Mule JD, Sanguinetti CM, De Benedetto F. Improving the management of patients with chronic cardiac and respiratory diseases by extending pulse-oximeter uses: the dynamic pulse-oximetry. Multidiscip Respir Med 2023; 18:922. [PMID: 38322131 PMCID: PMC10772858 DOI: 10.4081/mrm.2023.922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/21/2023] [Indexed: 02/08/2024] Open
Abstract
Respiratory and cardio-vascular chronic diseases are among the most common noncommunicable diseases (NCDs) worldwide, accounting for a large portion of health-care costs in terms of mortality and disability. Their prevalence is expected to rise further in the coming years as the population ages. The current model of care for diagnosing and monitoring NCDs is out of date because it results in late medical interventions and/or an unfavourable cost-effectiveness balance based on reported symptoms and subsequent inpatient tests and treatments. Health projects and programs are being implemented in an attempt to move the time of an NCD's diagnosis, as well as its monitoring and follow up, out of hospital settings and as close to real life as possible, with the goal of benefiting both patients' quality of life and health system budgets. Following the SARS-CoV-2 pandemic, this implementation received additional impetus. Pulseoximeters (POs) are currently used in a variety of clinical settings, but they can also aid in the telemonitoring of certain patients. POs that can measure activities as well as pulse rate and oxygen saturation as proxies of cardio-vascular and respiratory function are now being introduced to the market. To obtain these data, the devices must be absolutely reliable, that is, accurate and precise, and capable of recording for a long enough period of time to allow for diagnosis. This paper is a review of current pulse-oximetry (POy) use, with the goal of investigating how its current use can be expanded to manage not only cardio-respiratory NCDs, but also acute emergencies with telemonitoring when hospitalization is not required but the patients' situation is debatable. Newly designed devices, both "consumer" and "professional," will be scrutinized, particularly those capable of continuously recording vital parameters on a 24-hour basis and coupling them with daily activities, a practice known as dynamic pulse-oximetry.
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Affiliation(s)
- Stefano Nardini
- Scientific Committee, Italian Multidisciplinary Respiratory Society (SIPI), Milan
| | - Ulisse Corbanese
- Retired - Chief of Department of Anaesthesia and Intensive Care, Hospital of Vittorio Veneto (TV)
| | - Alberto Visconti
- ICT Engineer and Consultant, Italian Multidisciplinary Respiratory Society (SIPI), Milan
| | | | - Claudio M. Sanguinetti
- Chief Editor of Multidisciplinary Respiratory Medicine journal; Member of Steering Committee of Italian Multidisciplinary Respiratory Society (SIPI), Milan
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Peripheral perfusion index in well newborns at 6 to 72 h of life at different altitudes: a multi-center study in China. Eur J Pediatr 2023; 182:907-915. [PMID: 36525095 PMCID: PMC9899177 DOI: 10.1007/s00431-022-04725-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022]
Abstract
The purpose of this study is to obtain the reference range of peripheral perfusion index (PPI) of asymptomatic well newborns at 6 to 72 h of life at different altitudes. A population-based prospective cohort study was conducted in cities at different altitudes in China. Asymptomatic well newborns were enrolled consecutively from six hospitals with an altitude of 4 to 4200 m between February 1, 2020, and April 15, 2021. PPI was measured at 6, 12, 24, 48, and 72 h after birth on the right hand (pre-ductal) and either foot (post-ductal) using a Masimo SET Radical-7 oximeter. Fiftieth percentile reference curves of the pre- and post-ductal PPI values at 6-72 h after birth were generated using the Lambda Mu Sigma method. Linear mixed-effects regression was performed to determine the influence of different altitude levels on PPI values over different measurement time points. A total of 4257 asymptomatic well newborns were recruited for analysis. The median and quartile pre- and post-ductal PPI values at 6-72 h of life at different altitudes were 1.70 (1.20, 2.60) and 1.70 (1.10, 2.70) for all infants, 1.30 (1.10, 1.90) and 1.10 (0.88, 1.80) for infants at low altitude, 1.40 (1.00, 2.00) and 1.30 (0.99, 2.00) at mild altitudes, 1.90 (1.30, 2.50) and 1.80 (1.20, 2.70) at moderate altitudes, 1.80 (1.40, 3.50) and 2.20 (1.60, 4.30) for high altitudes, 3.20 (2.70, 3.70), and 3.10 (2.10, 3.30) for higher altitudes, respectively. Overall, both pre- and post-ductal PPI increased with altitude. The 50th percentile curves of pre- and post-ductal PPI values in well newborns at mild, low, moderate, and high altitudes were relatively similar, while the difference between the PPI curves of infants at higher altitudes and other altitudes was significantly different. Conclusions: With the increase of altitude, pre- and post-ductal PPI of newborns increases. Our study obtained the PPI reference values of asymptomatic well newborns at 6 to 72 h after birth at different altitudes from 4 to ≥ 4000 m. What is Known: • Monitoring hemodynamics is very important to neonates. As an accurate and reliable hemodynamic monitoring index, PPI can detect irreversible damage caused by insufficient tissue perfusion and oxygenation early, directly, noninvasively, and continuously. What is New: • Our study obtained the PPI reference values of asymptomatic well newborns at 6 to 72 h after birth at different altitudes from 4 to ≥ 4000 m. With the increase of altitude, pre- and post-ductal PPI of newborns increase with statistical significance. Therefore, the values and disease thresholds of PPI for asymptomatic neonates should be modified according to altitudes.
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Meza K, Vasquez-Loarte T, Rodriguez-Alarcon JF, San Roman O, Rojas-Camayo J, Mejia CR, Medina M, Zapata HA, Saarinen A, Bravo-Jaimes K. Critical congenital heart disease detection in the ANDES: Challenges and opportunities. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Gupta SK. Cyanotic congenital heart disease - Not always blue to provide a clue: Time to replace cyanosis with arterial desaturation! Ann Pediatr Cardiol 2022; 15:511-514. [PMID: 37152515 PMCID: PMC10158465 DOI: 10.4103/apc.apc_226_21] [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: 12/04/2021] [Revised: 02/11/2022] [Accepted: 04/07/2022] [Indexed: 03/03/2023] Open
Abstract
Despite right-to-left shunt, not all patients with so-called cyanotic congenital heart disease (CHD) are cyanosed at all times. Moreover, despite undisputed clinical utility, cyanosis is unreliable for the detection of arterial desaturation. Pulse oximetry, on the other hand, provides a much easier, reliable, and accurate method for detecting arterial desaturation. For optimal detection, therefore, it is perhaps sensible to replace cyanosis with pulse oximetry-based detection of arterial desaturation in all cases with suspected CHD.
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Affiliation(s)
- Saurabh Kumar Gupta
- Department of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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Huang Y, Zhong S, Zhang X, Kong L, Wu W, Yue S, Tian N, Zhu G, Hu A, Xu J, Zhu H, Sun A, Qin F, Wang Z, Wu S. Large scale application of pulse oximeter and auscultation in screening of neonatal congenital heart disease. BMC Pediatr 2022; 22:483. [PMID: 35962379 PMCID: PMC9373434 DOI: 10.1186/s12887-022-03540-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/02/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose To conduct a retrospective evaluation of a large clinical implementation of combined pulse oximeter (POX) and cardiac auscultation as a fast-screening device for congenital heart disease (CHD). Methods Every newborn in a large maternity healthcare center received auscultation and POX screening within 24 hours after delivery. When an abnormal heart murmur or SpO2 level was detected, an echocardiogram was ordered to confirm the diagnosis of CHD. Results From January 1, 2018 to December 31, 2019, there were 44,147 livebirths at the studied hospital where 498 suspected CHD were identified: 27 newborns by POX screening and 471 by cardiac auscultation. The diagnosis was further confirmed in 458 neonates through echocardiogram. This result put forth an overall diagnosis rate of 92.0%. Cardiac auscultation detected the majority of CHD cases 438 (95.6%) while POX only screened 20 (4.4%) cases. Interestingly, no CHD case was detected by both auscultation examination and POX screening. Auscultation detected most of the common types of CHD, but POX excelled in identifying rare and critical cases. POX screening alone had a very low accuracy of 74.07% in positive predict value (PPV). On the other hand, auscultation functioned well in terms of PPV and negative predict value (NPV) (92.99 and 99.95%, respectively), but the addition of POX improved the overall screening performance resulting in 100% NPV. We also validate the finding with the data 6 months after the study period. Conclusion Our study demonstrated that addition of pulse oximetry to routine cardiac auscultation could be used as an accurate and feasible screening for early screening of CHD in newborns in large-scale clinical practice.
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Affiliation(s)
- Yuqiang Huang
- Department of Pediatric Cardiothoracic Surgery, Linyi Maternal and Child Healthcare Hospital, Linyi City, Shandong Province, 276016, People's Republic of China
| | - Shiqing Zhong
- Department of Pediatric Cardiothoracic Surgery, Linyi Maternal and Child Healthcare Hospital, Linyi City, Shandong Province, 276016, People's Republic of China
| | - Xianmei Zhang
- Department of Ultrasound Diagnosis, Linyi Maternal and Child Healthcare Hospital, Linyi City, Shandong Province, People's Republic of China
| | - Linghui Kong
- Department of Ultrasound Diagnosis, Linyi Maternal and Child Healthcare Hospital, Linyi City, Shandong Province, People's Republic of China
| | - Wenli Wu
- Department of Obstetrics, Linyi Maternal and Child Healthcare Hospital, Linyi City, Shandong Province, People's Republic of China
| | - Shixia Yue
- Department of Obstetrics, Linyi Maternal and Child Healthcare Hospital, Linyi City, Shandong Province, People's Republic of China
| | - Ning Tian
- Department of Obstetrics, Linyi Maternal and Child Healthcare Hospital, Linyi City, Shandong Province, People's Republic of China
| | - Guanghua Zhu
- Department of Obstetrics, Linyi Maternal and Child Healthcare Hospital, Linyi City, Shandong Province, People's Republic of China
| | - Aiqin Hu
- Department of Obstetrics, Linyi Maternal and Child Healthcare Hospital, Linyi City, Shandong Province, People's Republic of China
| | - Juan Xu
- Department of Obstetrics, Linyi Maternal and Child Healthcare Hospital, Linyi City, Shandong Province, People's Republic of China
| | - Haijan Zhu
- Department of Obstetrics, Linyi Maternal and Child Healthcare Hospital, Linyi City, Shandong Province, People's Republic of China
| | - Airong Sun
- Department of Neonatal Medicine, Linyi Maternal and Child Healthcare Hospital, Linyi City, Shandong Province, People's Republic of China
| | - Fangling Qin
- Department of Neonatal Medicine, Linyi Maternal and Child Healthcare Hospital, Linyi City, Shandong Province, People's Republic of China
| | - Ziwen Wang
- Department of Pediatric Cardiothoracic Surgery, Linyi Maternal and Child Healthcare Hospital, Linyi City, Shandong Province, 276016, People's Republic of China
| | - Shiqiang Wu
- Department of Pediatric Cardiothoracic Surgery, Linyi Maternal and Child Healthcare Hospital, Linyi City, Shandong Province, 276016, People's Republic of China.
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20
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Impact of clinical research on public health policy of neonatal screening for congenital heart disease in China. Chin Med J (Engl) 2022; 135:1261-1263. [PMID: 35830175 PMCID: PMC9433059 DOI: 10.1097/cm9.0000000000002031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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21
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King C, Zadutsa B, Banda L, Phiri E, McCollum ED, Langton J, Desmond N, Qazi SA, Nisar YB, Makwenda C, Hildenwall H. Prospective cohort study of referred Malawian children and their survival by hypoxaemia and hypoglycaemia status. Bull World Health Organ 2022; 100:302-314B. [PMID: 35521039 PMCID: PMC9047421 DOI: 10.2471/blt.21.287265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/08/2022] [Accepted: 02/08/2022] [Indexed: 01/13/2023] Open
Abstract
Objective To investigate survival in children referred from primary care in Malawi, with a focus on hypoglycaemia and hypoxaemia progression. Methods The study involved a prospective cohort of children aged 12 years or under referred from primary health-care facilities in Mchinji district, Malawi in 2019 and 2020. Peripheral blood oxygen saturation (SpO2) and blood glucose were measured at recruitment and on arrival at a subsequent health-care facility (i.e. four hospitals and 14 primary health-care facilities). Children were followed up 2 weeks after discharge or their last clinical visit. The primary study outcome was the case fatality ratio at 2 weeks. Associations between SpO2 and blood glucose levels and death were evaluated using Cox proportional hazards models and the treatment effect of hospitalization was assessed using propensity score matching. Findings Of 826 children recruited, 784 (94.9%) completed follow-up. At presentation, hypoxaemia was moderate (SpO2: 90-93%) in 13.1% (108/826) and severe (SpO2: < 90%) in 8.6% (71/826) and hypoglycaemia was moderate (blood glucose: 2.5-4.0 mmol/L) in 9.0% (74/826) and severe (blood glucose: < 2.5 mmol/L) in 2.3% (19/826). The case fatality ratio was 3.7% (29/784) overall but 26.3% (5/19) in severely hypoglycaemic children and 12.7% (9/71) in severely hypoxaemic children. Neither moderate hypoglycaemia nor moderate hypoxaemia was associated with mortality. Conclusion Presumptive pre-referral glucose treatment and better management of hypoglycaemia could reduce the high case fatality ratio observed in children with severe hypoglycaemia. The morbidity and mortality burden of severe hypoxaemia was high; ways of improving hypoxaemia identification and management are needed.
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Affiliation(s)
- Carina King
- Department of Global Public Health, Karolinska Institutet, Tomtebogatan 18a, Stockholm, 17177, Sweden
| | | | - Lumbani Banda
- Parent and Child Health Initiative, Lilongwe, Malawi
| | | | - Eric D McCollum
- Global Program in Respiratory Sciences, Johns Hopkins University, Baltimore, United States of America
| | | | - Nicola Desmond
- Behaviour and Health Group, Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi
| | - Shamim Ahmad Qazi
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Yasir Bin Nisar
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | | | - Helena Hildenwall
- Department of Global Public Health, Karolinska Institutet, Tomtebogatan 18a, Stockholm, 17177, Sweden
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22
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Henderson A, Aguirre D, Singh A, Ewer AK. Temporal trends in routine predischarge pulse oximetry screening: 6 years' experience in a UK regional neonatal unit. Arch Dis Child Fetal Neonatal Ed 2022; 107:256-261. [PMID: 34686534 DOI: 10.1136/archdischild-2021-322303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 09/29/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate the continued impact of pulse oximetry screening (POS) in a regional neonatal unit (NNU) and identify trends in screening outcomes in comparison with our previous experience. DESIGN Retrospective review of admissions between April 2013 and March 2019 (the current study) and comparison with previously published data (the 2014 study). PATIENTS All infants >34 weeks completed gestation admitted to NNU as a result of positive POS. OUTCOME MEASURES Indication for admission, diagnosis, investigations and management. RESULTS There were 49 375 livebirths and 253 NNU admissions as a result of positive POS (0.5% of livebirths; compared with 0.8% in 2014). 247/253 (97.6%) of those admitted had a significant diagnosis requiring medical intervention (compared with 79% in 2014) and the proportion of healthy babies (with transitional circulation) admitted decreased from 21% to 2.4%.22 (9%) babies admitted as a result of a positive POS were found to have a previously undiagnosed congenital heart defect (CHD) of which eight were critical CHDs (CCHDs). This accounted for 73% of all undiagnosed CCHD undergoing POS. The antenatal detection rate of CCHD was 75% compared with 46% in 2014. No baby died or collapsed on the postnatal ward during the study period. The proportion of babies with CCHD identified before discharge improved from 94% to 99%. CONCLUSIONS Routine POS, in addition to antenatal screening and postnatal examination, continues to contribute to the improvement of our overall CCHD detection rates. We have demonstrated an overall reduction in the admission of healthy babies and therefore workload following a positive test.
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Affiliation(s)
- Amy Henderson
- Neonatal Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, Birmingham, UK
| | - Diana Aguirre
- Neonatal Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, Birmingham, UK
| | - Anju Singh
- Neonatal Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, Birmingham, UK
| | - Andrew K Ewer
- Neonatal Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, Birmingham, UK .,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
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23
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Wang B, Liu C, Yao Y, Lu Z, Yu R, CaiRen Z, Wang Z, Liu R, Wu Y, Yu Z. Establishing the reference interval for pulse oxygen saturation in neonates at high altitudes: protocol for a multicentre, open, cross-sectional study. BMJ Open 2022; 12:e060444. [PMID: 35459680 PMCID: PMC9036428 DOI: 10.1136/bmjopen-2021-060444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Establishing the reference interval for pulse oxygen saturation (SpO2) is essential for sensitively identifying neonatal hypoxaemia due to various causes. However, the reference interval for high altitudes has not yet been established, and existing studies have many limitations. This study will aim to establish the reference interval for various high altitudes and determine whether preductal and postductal measurements at the same altitude vary. METHODS AND ANALYSIS This is a multicentre, open, cross-sectional study, which will begin in February 2022. Approximately 2000 healthy full-term singleton neonates will be recruited from six hospitals (altitude ≥2000 m) in Qinghai Province, China. The participating hospitals will use a uniform pulse oximeter type. The measurements will be performed between 24 hours after birth and discharge. During the measurement, the neonate will be awake and quiet. Preductal and postductal measurements will be performed. The measurement time, site and results will be recorded and input, along with the collected basic information, into the perinatal cloud database. We will carry out strict quality control for basic information collection, measurement and data filing. We will perform descriptive statistics on the distribution range of the collected data, determine the lower limit value of the reference interval for each hospital and the corresponding altitude, perform curve fitting for the lower limit value, use the altitude as a covariate for the function corresponding to the fitted curve, establish the prediction equation and ultimately determine the reference intervals of each high altitude location. ETHICS AND DISSEMINATION Our protocol has been approved by the Medical Ethics Committee of all participating hospitals. We will publish our study results in academic conferences and peer-reviewed public journals. TRIAL REGISTRATION NUMBER NCT05115721.
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Affiliation(s)
- Bo Wang
- Department of Pediatrics, Suqian First People's Hospital, Suqian, Jiangsu, China
| | - Chongde Liu
- Department of Neonatology, Qinghai Women and Children's Hospital, Xining, Qinghai, China
| | - Yanli Yao
- Department of Neonatology, Qinghai Red Cross Hospital, Xining, Qinghai, China
| | - Zhihui Lu
- Department of Obstetrics and Gynecology, Qinghai University Affiliated Hospital, Xining, Qinghai, China
| | - Rong Yu
- Department of Neonatology, Geermu People's Hospital, Geermu, Qinghai, China
| | - Zhuoma CaiRen
- Department of Neonatology, Yushu Prefecture People's Hospital, Yushu Tibetan Autonomous Prefecture, Qinghai, China
| | - Zhixiu Wang
- Department of Neonatology, Guoluo Tibetan Autonomous Prefecture People's Hospital, Guoluo Tibetan Autonomous Prefecture, Qinghai, China
| | - Runwu Liu
- Department of Neonatology, Qinghai Women and Children's Hospital, Xining, Qinghai, China
| | - Yazhen Wu
- Department of Neonatology, Qinghai University Affiliated Hospital, Xining, Qinghai, China
| | - Zhangbin Yu
- Department of Neonatology, Shenzhen People's Hospital, Shenzhen, Guangdong, China
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24
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Martin GR, Schwartz BN, Hom LA, Donofrio MT. Lessons Learned from Infants with Late Detection of Critical Congenital Heart Disease. Pediatr Cardiol 2022; 43:580-585. [PMID: 34709442 DOI: 10.1007/s00246-021-02760-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/15/2021] [Indexed: 11/25/2022]
Abstract
Late detection of critical congenital heart disease (CCHD) is multifactorial and ill defined. We investigated the results of pulse oximetry screening (POS) and points in the care chain that contribute to delayed detection of CCHD. The medical records of 13 infants with delayed detection at a single pediatric cardiac center between 2013 and 2016 were identified and reviewed. Left heart obstructive lesions were the most common diagnosis (n = 8; 62%) and included coarctation of the aorta (n = 6), interrupted aortic arch with ventricular septal defect (n = 1), and critical aortic stenosis (n = 1). Tetralogy of Fallot (TOF) (n = 2), truncus arteriosus (n = 1), pulmonary atresia with ventricular septal defect (n = 1), and total anomalous pulmonary venous drainage (n = 1) made up the remainder of the conditions. Routine prenatal care was reported in most infants (10/13). Infants with late detection had either a true negative POS (10/13 infants) or no POS performed (3/13 infants). At the time of detection, 5/6 (83%) infants with coarctation had normal pulse oximetry values, whereas 6/7 (86%) infants with other CCHD developed abnormal pulse oximetry values. At diagnosis, 11/13 (85%) infants had significant signs or symptoms of clinical deterioration; only 2 infants were completely asymptomatic. Late detection of CCHD is uncommon and multifactorial. Eliminating late detection is dependent upon improving detection on screening obstetrical ultrasounds, enforcement of universal POS, and attention to the neonatal physical exam.
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Affiliation(s)
- Gerard R Martin
- Division of Cardiology and The Children's National Heart Institute, Children's National Hospital, 111 Michigan Avenue, N.W., Washington, D.C., 20010, USA.
- The George Washington School of Medicine, Washington, D.C., USA.
| | - Bryanna N Schwartz
- Division of Cardiology and The Children's National Heart Institute, Children's National Hospital, 111 Michigan Avenue, N.W., Washington, D.C., 20010, USA
- The George Washington School of Medicine, Washington, D.C., USA
| | - Lisa A Hom
- Division of Cardiology and The Children's National Heart Institute, Children's National Hospital, 111 Michigan Avenue, N.W., Washington, D.C., 20010, USA
- The George Washington School of Medicine, Washington, D.C., USA
| | - Mary T Donofrio
- Division of Cardiology and The Children's National Heart Institute, Children's National Hospital, 111 Michigan Avenue, N.W., Washington, D.C., 20010, USA
- The George Washington School of Medicine, Washington, D.C., USA
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25
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Singh Y, Chen SE. Impact of pulse oximetry screening to detect congenital heart defects: 5 years' experience in a UK regional neonatal unit. Eur J Pediatr 2022; 181:813-821. [PMID: 34618229 PMCID: PMC8821483 DOI: 10.1007/s00431-021-04275-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/07/2021] [Accepted: 09/25/2021] [Indexed: 11/28/2022]
Abstract
Pulse oximetry screening (POS) has been shown to be an effective, non-invasive investigation that can detect up to 50-70% of previously undiagnosed congenital heart defects (CHDs). The aims of this study were to assess the accuracy of POS in detection of CHDs and its impact on clinical practice. All eligible newborn infants born between 1 Jan 2015 and 31 Dec 2019 in a busy regional neonatal unit were included in this prospective observational study. A positive POS was classified as two separate measurements of oxygen saturation < 95%, or a difference of > 2% between pre- and post-ductal circulations. Overall, 23,614 infants had documented POS results. One hundred eighty nine (0.8%) infants had a true positive result: 6 had critical CHDs, 9 serious or significant CHDs, and a further 156/189 (83%) infants had significant non-cardiac conditions. Forty-three infants who had a normal POS were later diagnosed with the following categories of CHDs post-hospital discharge: 1 critical, 15 serious, 20 significant and 7 non-significant CHDs. POS sensitivity for detection of critical CHD was 85.7%, whereas sensitivity was only 33% for detection of major CHDs (critical and serious) needing surgery during infancy; specificity was 99.3%.Conclusion: Pulse oximetry screening showed moderate to high sensitivity in detection of undiagnosed critical CHDs; however, it failed to detect two-third of major CHDs. Our study further emphasises the significance of adopting routine POS to detect critical CHDs in the clinical practice. However, it also highlights the need to develop new, innovative methods, such as perfusion index, to detect other major CHDs missed by current screening tools. What is Known: • Pulse oximetry screening is cost effective, acceptable, easy to perform and has moderate sensitivity and high specificity in detection of critical congenital heart defects. • Pulse oximetry screening has been implemented many countries including USA for detection of critical congenital heart defects, but it is not currently recommended by the UK National Screening Committee. What is New: • To our knowledge, this is the first study describing postnatal detection and presentation of all the infants with congenital heart defects over a period of 5 years, including those not detected on the pulse oximetry screening, on the clinical practice. • It emphasises that further research required to detect critical congenital heart defects and other major CHDs which can be missed on the screening tools currently employed in clinical practice.
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Affiliation(s)
- Yogen Singh
- Department of Paediatrics - Neonatology and Paediatric Cardiology, Addenbrooke’s Hospital, NICU, Cambridge University Hospitals NHS Foundation Trust and University of Cambridge School of Clinical Medicine, Box 402, Biomedical Campus, CB2 0QQ Cambridge, UK
- Loma Linda University School of Medicine, Loma Linda, CA USA
| | - Si Emma Chen
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
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26
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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.
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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
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27
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Abstract
The possibility of pulse oximetry screening (POS) for congenital heart defects was first described over 20 years ago. Since then, an accumulation of research evidence and clinical practice experience has established POS as an important test to detect critical congenital heart defects (CCHDs). POS meets the criteria for universal screening and professional bodies around the globe have recommended universal POS. Many countries have already adopted POS while several others are working towards its implementation. In low and low-middle-income countries (LLMIC), POS has the additional potential for reducing morbidity and mortality from neonatal sepsis. This review summarises the evidence for POS and looks at current global uptake and different approaches to the implementation of POS.
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Affiliation(s)
- Asad Abbas
- Department of Neonatology, Birmingham Women's Hospital NHS Trust, Birmingham, United Kingdom.
| | - Andrew K Ewer
- Department of Neonatology, Birmingham Women's Hospital NHS Trust, Birmingham, United Kingdom; Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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28
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Zhang YL, Bai HT. A Study on Clinical Screening of Neonatal Congenital Heart Disease in Jinjiang City. Int J Gen Med 2021; 14:2599-2609. [PMID: 34168486 PMCID: PMC8216754 DOI: 10.2147/ijgm.s311582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/25/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study explored the feasibility of congenital heart disease (CHD) screening by combining a percutaneous oxygen saturation (POX) test with cardiac auscultation method in neonates. METHODS POX tests and cardiac auscultation were used concurrently to screen 8305 neonates born in Jinjiang City Hospital between January 2016 and December 2018 for CHD. The positive screening results (positive POX or positive cardiac auscultation) were confirmed with echocardiography, while any false negative results were identified through follow-up and parent feedback. Sensitivity, specificity, positive/negative predictive values, Youden's index, and the area under the receiver operator characteristic curve (AUC) of the single use and combined use of the two methods (a POX test and auscultation) were calculated, and the results were compared. RESULTS Among 8305 neonates, 22 cases were positive for POX alone, of which 6 cases were diagnosed by echocardiography; 83 cases were positive for cardiac auscultation alone, of which 47 cases were diagnosed by echocardiography; and 8 cases were positive for both methods, all of which were confirmed by echocardiography. Four more cases were confirmed during follow-up. Sensitivity, specificity, and the positive and negative predictive values of combined screening were 93.85%, 99.37%, 53.98% and 99.95%, respectively, while Youden's index was 0.93, and the AUC was 0.966. Sixty-five cases of CHD were diagnosed, the total incidence being 7.82%, and a ventricular septal defect was found to be the most common type. CONCLUSION The combination of POX test and cardiac auscultation as a screening method for neonatal CHD can reduce missed diagnoses and increase the detection rate of CHD in newborn infants.
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Affiliation(s)
- Yu-Lin Zhang
- Department of Pediatric, Jinjiang Municipal Hospital, Jinjiang, People’s Republic of China
| | - Hai-Tao Bai
- Department of Pediatrics, First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China
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29
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Song J, Huang X, Zhao S, Chen J, Chen R, Wu G, Xu Z. Diagnostic value of pulse oximetry combined with cardiac auscultation in screening congenital heart disease in neonates. J Int Med Res 2021; 49:3000605211016137. [PMID: 34044642 PMCID: PMC8165855 DOI: 10.1177/03000605211016137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the feasibility and reliability of pulse oximetry combined with cardiac auscultation in screening neonatal congenital heart disease (CHD). METHODS This was a retrospective, observational, screening study. All newborns included in the study were at the Second Affiliated Hospital of Wenzhou Medical University from July 2019 to January 2020. Primary screening of CHD was conducted by pulse oximetry combined with cardiac auscultation assays. Indices, including sensitivity, specificity, the positive/negative predictive value, the positive/negative likelihood ratio, and the diagnostic odds ratio, were calculated. The area under the relative operating characteristic curve of the subjects was measured. RESULTS A total of 3327 neonates were enrolled, among whom 139 were diagnosed with CHD and the incidence of CHD was 4.2%. The sensitivity, specificity, diagnostic odds ratio, and area under the relative operating characteristic curve of pulse oximetry combined with cardiac auscultation were 89.9%, 94.7%, 169.0, and 0.923, respectively. CONCLUSIONS Pulse oximetry combined with cardiac auscultation is a novel screening method with acceptable accuracy and feasibility for neonatal CHD. This combination method is worth promoting widely.
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Affiliation(s)
- Jiajia Song
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xianping Huang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shenzhi Zhao
- The Second Clinical Medicine School, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiajia Chen
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ruiheng Chen
- Department of Pediatric Cardiac Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Guowei Wu
- Department of Pediatric Cardiology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhangye Xu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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30
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Murni IK, Wirawan MT, Patmasari L, Sativa ER, Arafuri N, Nugroho S, Noormanto. Delayed diagnosis in children with congenital heart disease: a mixed-method study. BMC Pediatr 2021; 21:191. [PMID: 33882901 PMCID: PMC8059230 DOI: 10.1186/s12887-021-02667-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 04/13/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Delayed diagnosis of congenital heart disease (CHD) causes significant morbidity and mortality. We aimed to determine the proportion of delayed diagnosis of CHD and factors related to the delayed diagnosis. METHODS A prospective cohort study with mixed-methods was conducted in Dr. Sardjito Hospital, Yogyakarta, Indonesia. Patients aged < 18 years with newly diagnosed CHD and echocardiography confirmed CHD were included. Data were recorded from medical records and interviews from direct caregivers. Logistic regression was used to identify independent factors associated with the delay. RESULTS A total of 838 patients were included with median age of 2.9 years (0-17.7 years), with female predominance (54.2%, n = 454). The proportions of delayed diagnosis were 60.8% (510), 54.9% (373) and 86.2% (137) in all children with CHD, acyanotic and cyanotic CHD, respectively. Delayed diagnosis by doctor was the most common cause, followed by delayed diagnosis related to midwifery care, financial, referral/follow-up, and social factors. In multivariate analysis, cyanotic CHD, residence outside the city, non-syndromic, low family income, normal labour and at term gestation at birth were independently associated with the delay. At diagnosis, heart failure and pulmonary hypertension occurred in 414 (49.4%) and 132 (15.8%) children with CHD, respectively. CONCLUSIONS Six in ten children with CHD were diagnosed with significant delay. Delayed diagnosis by doctor was the most common cause. Children with cyanotic CHD, residence outside the city, non-syndromic, low family income, normal labour and at term gestation at birth were independently associated with the delay. Comorbid complications in delayed diagnosis of CHD were prevalent.
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Affiliation(s)
- Indah K Murni
- Department of Child Health, Dr. Sardjito Hospital / Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jalan Kesehatan No 1, Sekip, Yogyakarta, 55281, Indonesia.
| | - Muhammad Taufik Wirawan
- Department of Child Health, Dr. Sardjito Hospital / Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jalan Kesehatan No 1, Sekip, Yogyakarta, 55281, Indonesia
| | - Linda Patmasari
- Department of Child Health, Dr. Sardjito Hospital / Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jalan Kesehatan No 1, Sekip, Yogyakarta, 55281, Indonesia
| | - Esta R Sativa
- Department of Child Health, Dr. Sardjito Hospital / Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jalan Kesehatan No 1, Sekip, Yogyakarta, 55281, Indonesia
| | - Nadya Arafuri
- Department of Child Health, Dr. Sardjito Hospital / Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jalan Kesehatan No 1, Sekip, Yogyakarta, 55281, Indonesia
| | - Sasmito Nugroho
- Department of Child Health, Dr. Sardjito Hospital / Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jalan Kesehatan No 1, Sekip, Yogyakarta, 55281, Indonesia
| | - Noormanto
- Department of Child Health, Dr. Sardjito Hospital / Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jalan Kesehatan No 1, Sekip, Yogyakarta, 55281, Indonesia
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Makkar A, Milsten J, McCoy M, Szyld EG, Lapadula MC, Ganguly A, DeShea LA, Ponniah U. Tele-Echocardiography for Congenital Heart Disease Screening in a Level II Neonatal Intensive Care Unit with Hybrid Telemedicine System. Telemed J E Health 2021; 27:1136-1142. [PMID: 33449839 DOI: 10.1089/tmj.2020.0440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Introduction: The nationwide shortage of pediatric cardiologists in medically underserved areas poses a challenge to congenital heart disease (CHD) screening requiring echocardiography, resulting in transfer of neonates to regional Level III/IV Neonatal Intensive Care Units (NICUs). This study aimed to evaluate the accuracy, safety, and cost-effectiveness of tele-echocardiography for advanced CHD screening at a Level II NICU managed by a hybrid telemedicine system. Methods: Retrospective chart review of infants requiring tele-echocardiography at a Level II NICU. Patient demographics, echocardiography indications, and findings were analyzed. Agreement between tele-echocardiography and conventional echocardiography findings was assessed. Transport cost savings were calculated based on preventable transfers to Level IV NICU. Descriptive statistics were computed for demographic and clinical variables. Results: Over 5 years, 52 infants were screened for CHD. Thirty-two infants (62%) had findings consistent with minor CHD or normal neonatal transitional physiology. Twenty infants (38%) had abnormal findings requiring follow-up with either a conventional echocardiography as inpatient at the regional Level IV NICU or as outpatient after discharge. Only 5 infants (10%) required transfer to a Level IV NICU for CHD management, whereas 15 infants (29%) were scheduled for outpatient follow-up. Strong agreement was noted between tele-echocardiography and conventional echocardiography findings. No case of critical congenital heart disease (CCHD) was missed. Tele-echocardiography saved $260,000 in transport costs. Conclusions: Tele-echocardiography can be accurate, safe, and effective in CHD screening, preventing unnecessary transfer of most infants to regional Level III/IV NICUs, saving transfer costs.
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Affiliation(s)
- Abhishek Makkar
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Jennifer Milsten
- University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | - Mike McCoy
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Edgardo G Szyld
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Maria C Lapadula
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Abhrajit Ganguly
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Lise A DeShea
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Umakumaran Ponniah
- Division of Cardiology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Sotodate G, Oyama K, Saiki H, Matsumoto A, Konishi Y, Toya Y, Takashimizu N, Tsuchiya S. Comparing risk factors associated with the late detection of critical congenital heart disease at different facility levels. J Obstet Gynaecol Res 2020; 47:961-967. [PMID: 33350039 DOI: 10.1111/jog.14623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/25/2020] [Accepted: 12/10/2020] [Indexed: 11/30/2022]
Abstract
AIMS Critical congenital heart disease (CCHD) requires surgery or catheter intervention within the first year of life; delayed diagnoses result in worsened outcomes. In Japan, there are few reports of delayed CCHD diagnosis. We investigated the diagnoses and factors associated with the late detection of CCHD. METHODS This retrospective cohort study evaluated 88 CCHD infants admitted to a level IV facility. We compared the late detection rates across facility levels of neonatal care and CCHD characteristics. RESULTS Critical congenital heart disease was identified prenatally in 46 (52%) infants: early (≤3 days postnatally) in 29 (33%) and late (≥4 days postnatally) in 13 (15%). The oxygen saturation of 27 of 29 infants with early detection and 7 of 13 infants with late detection was measured using pulse oximetry within 3 days postnatally. Factors associated with the late detection of CCHD were lack of clinical recognition of symptoms in five infants, referral to higher-level facilities after discharge in four infants, and definitive diagnosis not confirmed using echocardiography in four infants. The most common factors associated with late detection were referral to higher-level facilities after discharge in level I facilities and definitive diagnosis not confirmed using echocardiography in level II facilities. CONCLUSION Critical congenital heart disease may require advanced knowledge and echocardiographic techniques for diagnosis. Pulse oximetry and telemedicine should also be incorporated in the diagnostic algorithm. Improvement in these factors might contribute to reducing the late detection of CCHD.
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Affiliation(s)
| | - Kotaro Oyama
- Department of Pediatrics, Iwate Medical University, Morioka, Japan
| | - Hirofumi Saiki
- Department of Pediatrics, Iwate Medical University, Morioka, Japan
| | | | - Yu Konishi
- Department of Pediatrics, Iwate Medical University, Morioka, Japan
| | - Yukiko Toya
- Department of Pediatrics, Iwate Medical University, Morioka, Japan
| | - Nao Takashimizu
- Department of Pediatrics, Iwate Medical University, Morioka, Japan
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Mat Bah MN, Sapian MH, Alias EY. Birth prevalence and late diagnosis of critical congenital heart disease: A population-based study from a middle-income country. Ann Pediatr Cardiol 2020; 13:320-326. [PMID: 33311920 PMCID: PMC7727899 DOI: 10.4103/apc.apc_35_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/28/2020] [Accepted: 08/08/2020] [Indexed: 11/12/2022] Open
Abstract
Aims: There are limited data regarding critical congenital heart disease (CCHD) from middle-income countries (MIC). This study aims to determine the birth prevalence, rate of late diagnosis, and influence of timing of diagnosis on the outcome of CCHD. Setting and Design: Retrospective observational cohort study in the State of Johor, Malaysia. Subjects and Methods: All infants born between January 2006 and December 2015 with a diagnosis of CCHD, defined as infants with duct-dependent lesions or cyanotic heart disease who may die without early intervention. The late diagnosis was defined as a diagnosis of CCHD after 3 days of age. Results: Congenital heart disease was diagnosed in 3557 of 531,904 live-born infants and were critical in 668 (18.7%). Of 668, 347 (52%) had duct-dependent pulmonary circulation. The birth prevalence of CCHD was 1.26 (95% confidence interval: 1.16–1.35) per 1000 live births, with no significant increase over time. The median age of diagnosis was 4 days (Q1 1, Q3 26), with 61 (9.1%) detected prenatally, and 342 (51.2%) detected late. The highest rate of late diagnosis was observed in coarctation of the aorta with a rate of 74%. Trend analysis shows a statistically significant reduction of late diagnosis and a significant increase in prenatal detection. However, Cox regression analysis shows the timing of diagnosis does not affect the outcome of CCHD. Conclusions: Due to limited resources in the MIC, the late diagnosis of CCHD is high but does not affect the outcome. Nevertheless, the timing of diagnosis has improved over time.
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Affiliation(s)
- Mohd Nizam Mat Bah
- Department of Pediatrics, Ministry of Health, Hospital Sultanah Aminah, Johor Bahru, Malaysia
| | - Mohd Hanafi Sapian
- Department of Pediatrics, Ministry of Health, Hospital Sultanah Aminah, Johor Bahru, Malaysia
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Gopalakrishnan S, Karmani S, Pandey A, Singh N, Ratheesh Kumar J, Praveen R, Sodhi K. Pulse oximetry screening to detect critical congenital heart diseases in asymptomatic neonates. Med J Armed Forces India 2020; 77:214-219. [PMID: 33867640 DOI: 10.1016/j.mjafi.2020.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/15/2020] [Indexed: 10/22/2022] Open
Abstract
Background Critical congenital heart diseases (CCHDs), 10% to 25% of all CHD, are duct-dependent defects that are life threatening without intervention in the neonatal period or infancy. One third of neonates with CCHDs are discharged home undetected and have a poorer outcome. Pulse oximetry screening before discharge is increasingly being used to diagnose CCHDs in developed countries. Methods This prospective observational study conducted at a tertiary care hospital from September 2016 to March 2019 screened all asymptomatic intramural neonates after 24 hours of life using a Masimo pulse oximeter with signal extraction technology using the standard American Academy of Pediatrics algorithm. A positive screen was followed by a confirmatory echocardiography (gold standard) and a negative screen by clinical examination at 6, 10 and 14 weeks and identification of readmissions during the study period. Results A total of 1855 neonates (82.99% of the eligible 2235 neonates) underwent screening at a mean (SD) age at screening of 32.4 (6.8) hours and took a mean (SD) time of 3.5 (1.2) minutes. The sensitivity, specificity, positive and negative predictive value of pulse oximetry screening for detection of CCHDs in asymptomatic neonates was 75% (95% CI: 28.91% to 96.59%), 99.29% (95% CI: 98.79% to 99.60%), 18.75% (95% CI: 5.80% to 43.80%) and 99.94% (95% CI: 99.66 to 99.99%), respectively. Conclusion Pulse oximetry screening of asymptomatic neonates between 24 and 48 hours of life improved the detection of CCHDs with high specificity and negative predictive value, moderate sensitivity and a reasonably low false positivity rate.
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Affiliation(s)
| | - Saurabh Karmani
- Associate Professor (Pediatrics), MM Institute of Medical Sciences & Research, Ambala, India
| | - Abhishek Pandey
- Classified Specialist (Pediatrics), Military Hospital Golconda, Hyderabad, India
| | - Navreet Singh
- Senior Adviser (Medicine) & Cardiologist, AFCME, New Delhi, India
| | - J Ratheesh Kumar
- Senior Adviser (Medicine) & Cardiologist, Command Hospital (Eastern Command), Kolkata, India
| | - Ramar Praveen
- Classified Specialist (Pediatrics) & Neonatologist, Command Hospital (Western Command), Chandimandir, India
| | - Kirandeep Sodhi
- Professor (Pediatrics), MM Institute of Medical Sciences & Research, Ambala, India
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Abstract
AIM To determine the false-positive rate of pulse oximetry screening at moderate altitude, presumed to be elevated compared with sea level values and assess change in false-positive rate with time. METHODS We retrospectively analysed 3548 infants in the newborn nursery in Albuquerque, New Mexico, (elevation 5400 ft) from July 2012 to October 2013. Universal pulse oximetry screening guidelines were employed after 24 hours of life but before discharge. Newborn babies between 36 and 36 6/7 weeks of gestation, weighing >2 kg and babies >37 weeks weighing >1.7 kg were included in the study. Log-binomial regression was used to assess change in the probability of false positives over time. RESULTS Of the 3548 patients analysed, there was one true positive with a posteriorly-malaligned ventricular septal defect and an interrupted aortic arch. Of the 93 false positives, the mean pre- and post-ductal saturations were lower, 92 and 90%, respectively. The false-positive rate before April 2013 was 3.5% and after April 2013, decreased to 1.5%. There was a significant decrease in false-positive rate (p = 0.003, slope coefficient = -0.082, standard error of coefficient = 0.023) with the relative risk of a false positive decreasing at 0.92 (95% CI 0.88-0.97) per month. CONCLUSION This is the first study in Albuquerque, New Mexico, reporting a high false-positive rate of 1.5% at moderate altitude at the end of the study in comparison to the false-positive rate of 0.035% at sea level. Implementation of the nationally recommended universal pulse oximetry screening was associated with a high false-positive rate in the initial period, thought to be from the combination of both learning curve and altitude. After the initial decline, it remained steadily elevated above sea level, indicating the dominant effect of moderate altitude.
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Wackernagel D, Blennow M, Hellström A. Accuracy of pulse oximetry in preterm and term infants is insufficient to determine arterial oxygen saturation and tension. Acta Paediatr 2020; 109:2251-2257. [PMID: 32043645 DOI: 10.1111/apa.15225] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/05/2020] [Accepted: 02/10/2020] [Indexed: 11/30/2022]
Abstract
AIM Oxygen saturation is frequently monitored with pulse oximetry to assess vital signs in critically ill patients. Optimally, pulse oximetry closely tracks arterial oxygen tension (PaO2 ), which provides guidance in oxygen titration. We investigated whether monitoring peripheral oxygen saturation (SpO2 ) could accurately guide oxygen titration in newborn infants. METHODS Twenty seven thousand two hundred thirty seven SpO2 readings were retrospectively paired with arterial oxygen saturation (SaO2 ) and PaO2 results from blood gas analyses performed in infants with arterial catheters in place. RESULTS SpO2 overestimated SaO2 readings by 2.9 ± 5.8%. When pulse oximetry readings were within the defined oxygen saturation target range, 7809 (20.9%) SaO2 values were below and 2830 (7.6%) exceeded the target range. In 57% of patients, PaO2 levels < 6 kPa was diagnosed while SpO2 readings were > 90%. PaO2 > 11 kPa was recorded in 19% of cases, when SpO2 readings were < 95%. Infants treated with supplemental oxygen showed a threefold increased risk of hypoxaemia compared to infants breathing room air. Sensitivity and specificity for detecting upper and lower target range limits were fair to good. For SpO2 values below 91%, ISO quality criteria were no longer fulfilled. CONCLUSIONS Based on arterial blood gas analyses as reference, pulse oximetry readings did not fulfil the performance requirements for titrating oxygen in neonatal patients.
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Affiliation(s)
- Dirk Wackernagel
- Department of Neonatal Medicine Karolinska University Hospital Stockholm Sweden
- Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm Sweden
| | - Mats Blennow
- Department of Neonatal Medicine Karolinska University Hospital Stockholm Sweden
- Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm Sweden
| | - Ann Hellström
- Department of Ophthalmology Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
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Mukerji A, Shafey A, Jain A, Cohen E, Shah PS, Sander B, Shah V. Pulse oximetry screening for critical congenital heart defects in Ontario, Canada: a cost-effectiveness analysis. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2020; 111:804-811. [PMID: 31907759 PMCID: PMC7501328 DOI: 10.17269/s41997-019-00280-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 12/03/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Previously conducted cost-effectiveness analyses of pulse oximetry screening (POS) for critical congenital heart defects (CCHDs) have shown it to be a cost-effective endeavour, but the geographical setting of Ontario in relation to its vast yet sparsely populated regions presents unique challenges. The objective of this study was to estimate the cost-effectiveness of POS for CCHD in Ontario, Canada. METHODS A cost-effectiveness analysis, comparing POS to no POS, was conducted from the Ontario healthcare payer perspective using a Markov model. The base case was defined as a well-appearing newborn at 24 h of age. Outcome measures, including quality-adjusted life months (QALMs), lifetime costs, and incremental cost-effectiveness ratios (ICER) [ΔCost/ΔQALMs], were calculated over a lifetime horizon. All outcomes were discounted at 1.5% per year. Cost-effectiveness was assessed using an a priori ICER threshold of CAD$4166.67 per QALM (equivalent to CAD$50,000 per quality-adjusted life year). Deterministic and probabilistic sensitivity analyses were conducted to assess parameter uncertainty. RESULTS Implementation of POS is expected to lead to timely diagnosis of 51 CCHD cases annually. The incremental cost of performing POS was estimated to be $27.27 per screened individual, with a gain of 0.02455 QALMs. This yielded an ICER of CAD$1110.79 per QALM, well below the pre-determined threshold. The probabilistic sensitivity analysis estimated a 92.3% chance of routine implementation of POS being cost-effective. CONCLUSION Routine implementation of POS for CCHD in Ontario is expected to be cost-effective.
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Affiliation(s)
- Amit Mukerji
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
| | - Amy Shafey
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Amish Jain
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Eyal Cohen
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Prakesh S Shah
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Vibhuti Shah
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Cost-Effectiveness Analysis of Pulse Oximetry Screening in the Full-Term Neonates for Diagnosis of Congenital Heart Disease: A Systematic Review. IRANIAN JOURNAL OF PEDIATRICS 2020. [DOI: 10.5812/ijp.105393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Context: Congenital heart disease (CHD) is a leading cause of mortality by birth defects with significant social and economic burden. Pulse oximetry as a safe and non-invasive screening method, and with its potential for early detection of CHD has improved neonatal health outcomes. Objectives: The aim of this study was to systematically review economic evaluation studies that compared pulse oximetry with current programs to diagnose early detection of CHD in full-term newborns. Data Sources: A systematic review was conducted according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, and related articles published from 1995 up to March 2020 were searched in different databases (MEDLINE, EMBASE, PubMed, Science Direct, Google Scholar, Scopus, NHS EED, Science Citation Index, MagIran, Cochrane Library, EconLit and SID). The articles were selected based on inclusion and exclusion criteria. Consolidated health economic evaluation reporting standards (CHEERS) statement checklist was used to qualitatively evaluate the papers. Overall, 7 articles were included in the study. Results: Timely diagnosis was considered as main effectiveness health outcome in most studies. The highest and lowest values of incremental cost-effectiveness ratio (in two-phase studies) were €139,000 and $100 per infant in the Netherlands and Colombia respectively; and (in one-phase studies) were £24,000 and £1,489 per infant both belonging to the UK. Implementing pulse oximetry method concurrent with the clinical examination is more cost-effective. The reviewed studies had been conducted in high-income and upper middle-income countries; therefore, when the results are generalizing by policy makers in different health systems, a substantial precaution approach is needed.
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El Idrissi Slitine N, Bennaoui F, Sable CA, Martin GR, Hom LA, Fadel A, Moussaoui S, Inajjarne N, Boumzebra D, Mouaffak Y, Younous S, Boukhanni L, Maoulainine FMR. Pulse Oximetry and Congenital Heart Disease Screening: Results of the First Pilot Study in Morocco. Int J Neonatal Screen 2020; 6:53. [PMID: 33123634 PMCID: PMC7570348 DOI: 10.3390/ijns6030053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/26/2020] [Indexed: 11/17/2022] Open
Abstract
Congenital heart disease (CHD) is the most common congenital malformation. Diagnosis of critical congenital heart disease (CCHD), the most severe type of congenital heart disease, in a newborn may be difficult. The addition of CCHD screening, using pulse oximetry, to clinical assessment significantly improves the rate of detection. We conducted a pilot study in Morocco on screening neonates for critical congenital heart disease. This study was conducted in the maternity ward of Mohammed VI University Hospital of Marrakesh, Morocco, and included asymptomatic newborns delivered between March 2019 and January 2020. The screening of CCHD was performed by pulse oximetry measuring the pre- and post-ductal saturation. Screening was performed on 8013/10,451 (76.7%) asymptomatic newborns. According to the algorithm, 7998 cases passed the screening test (99.82%), including one inconclusive test that was repeated an hour later and was normal. Fifteen newborns failed the screening test (0.18%): five CCHD, five false positives, and five CHD but non-critical. One false negative case was diagnosed at 2 months of age. Our results encourage us to strengthen screening for CCHD by adding pulse oximetry to the routine newborn screening panel.
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Affiliation(s)
- Nadia El Idrissi Slitine
- Neonatal Intensive Care Unit, Mother and Child Hospital, Mohammed VI University Hospital, Marrakech 40000, Morocco; (F.B.); (A.F.); (S.M.); (N.I.); (F.M.R.M.)
- Laboratory Childhood, Health and Development, Marrakesh Medical School, Cadi Ayyad University, Marrakech 40000, Morocco; (Y.M.); (S.Y.)
| | - Fatiha Bennaoui
- Neonatal Intensive Care Unit, Mother and Child Hospital, Mohammed VI University Hospital, Marrakech 40000, Morocco; (F.B.); (A.F.); (S.M.); (N.I.); (F.M.R.M.)
- Laboratory Childhood, Health and Development, Marrakesh Medical School, Cadi Ayyad University, Marrakech 40000, Morocco; (Y.M.); (S.Y.)
| | - Craig A Sable
- Children's National Heart Institute, George Washington University School of Medicine, Washington, DC 20010, USA; (C.A.S.); (G.R.M.); (L.A.H.)
| | - Gerard R Martin
- Children's National Heart Institute, George Washington University School of Medicine, Washington, DC 20010, USA; (C.A.S.); (G.R.M.); (L.A.H.)
| | - Lisa A Hom
- Children's National Heart Institute, George Washington University School of Medicine, Washington, DC 20010, USA; (C.A.S.); (G.R.M.); (L.A.H.)
| | - Amal Fadel
- Neonatal Intensive Care Unit, Mother and Child Hospital, Mohammed VI University Hospital, Marrakech 40000, Morocco; (F.B.); (A.F.); (S.M.); (N.I.); (F.M.R.M.)
| | - Soufiane Moussaoui
- Neonatal Intensive Care Unit, Mother and Child Hospital, Mohammed VI University Hospital, Marrakech 40000, Morocco; (F.B.); (A.F.); (S.M.); (N.I.); (F.M.R.M.)
- Laboratory Childhood, Health and Development, Marrakesh Medical School, Cadi Ayyad University, Marrakech 40000, Morocco; (Y.M.); (S.Y.)
| | - Nadir Inajjarne
- Neonatal Intensive Care Unit, Mother and Child Hospital, Mohammed VI University Hospital, Marrakech 40000, Morocco; (F.B.); (A.F.); (S.M.); (N.I.); (F.M.R.M.)
| | - Drissi Boumzebra
- Cardio-Vascular Surgery Center, Arazzi Hospital, Mohammed VI University Hospital, Marrakech 40000, Morocco;
| | - Youssef Mouaffak
- Laboratory Childhood, Health and Development, Marrakesh Medical School, Cadi Ayyad University, Marrakech 40000, Morocco; (Y.M.); (S.Y.)
- Pediatric Intensive Care, Mother and Child Hospital, Mohammed VI University Hospital, Marrakech 40000, Morocco
| | - Said Younous
- Laboratory Childhood, Health and Development, Marrakesh Medical School, Cadi Ayyad University, Marrakech 40000, Morocco; (Y.M.); (S.Y.)
- Pediatric Intensive Care, Mother and Child Hospital, Mohammed VI University Hospital, Marrakech 40000, Morocco
| | - Lahcen Boukhanni
- Gyneco-Obstetrical Unit, Mother and Child Hospital, Mohammed VI University Hospital, Marrakech 40000, Morocco;
| | - Fadl Mrabih Rabou Maoulainine
- Neonatal Intensive Care Unit, Mother and Child Hospital, Mohammed VI University Hospital, Marrakech 40000, Morocco; (F.B.); (A.F.); (S.M.); (N.I.); (F.M.R.M.)
- Laboratory Childhood, Health and Development, Marrakesh Medical School, Cadi Ayyad University, Marrakech 40000, Morocco; (Y.M.); (S.Y.)
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Khammari Nystrom F, Petersson G, Stephansson O, Johansson S, Altman M. Diagnostic values of the femoral pulse palpation test. Arch Dis Child Fetal Neonatal Ed 2020; 105:375-379. [PMID: 31597727 DOI: 10.1136/archdischild-2019-317066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 08/15/2019] [Accepted: 09/24/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To calculate diagnostic values of the femoral pulse palpation to detect coarctation of the aorta or other left-sided obstructive heart anomalies in newborn infants. DESIGN Population-based cohort study. SETTING Stockholm-Gotland County 2008-2012. PATIENTS All singleton live-born infants without chromosomal trisomies, at ≥35 gestational weeks, followed-up until 1-2 years of age. MAIN OUTCOME MEASURES Diagnostic values and ORs for the femoral pulse test and subsequent diagnosis of coarctation of the aorta or left-sided obstructive heart malformation. RESULTS Among the 118 592 included infants, 432 had weak or absent femoral pulses at the newborn examination. Seventy-eight infants were diagnosed with coarcation of the aorta and 48 with other left-sided obstructive heart malformations. The diagnostic values for the femoral pulse palpation test to detect coarctation of the aorta were: sensitivity: 19.2%, specificity: 99.6, positive predictive value: 3.5% and negative predictive value: 99.9%. For left-sided heart malformations: sensitivity: 8.3%, specificity: 99.6%, positive predictive value: 0.9% and negative predictive value: 100%. Sensitivity for coarctation of the aorta increased from 16.7% when examined at <12 hours of age to 30.0% at ≥96 hours of age. CONCLUSIONS The femoral pulse test to detect coarctation of the aorta and left-sided heart malformations has limited sensitivity, whereas specificity is high. As many infants with life-threatening cardiac malformations leave the maternity ward undiagnosed, further efforts are necessary to improve the diagnostic yield of the routine newborn examination.
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Affiliation(s)
- Fatine Khammari Nystrom
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Petersson
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Olof Stephansson
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.,Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Johansson
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Science and Education, Sodersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Maria Altman
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
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Martin GR, Ewer AK, Gaviglio A, Hom LA, Saarinen A, Sontag M, Burns KM, Kemper AR, Oster ME. Updated Strategies for Pulse Oximetry Screening for Critical Congenital Heart Disease. Pediatrics 2020; 146:peds.2019-1650. [PMID: 32499387 DOI: 10.1542/peds.2019-1650] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2019] [Indexed: 11/24/2022] Open
Abstract
Seven years after its addition to the US Recommended Uniform Screening Panel, newborn screening for critical congenital heart disease (CCHD) using pulse oximetry became mandatory in the United States. Although CCHD newborn screening reduces morbidity and mortality, there remain important opportunities to improve. An expert panel convened for a 1-day meeting in September 2018, including subject matter experts and representatives from stakeholder organizations. Presentations on CCHD outcomes, variations in approach to screening, and data and quality improvement helped identify improvement opportunities. The expert panel concluded that sufficient evidence exists to recommend modifying the current American Academy of Pediatrics algorithm by (1) requiring an oxygen saturation of at least 95% in both (formerly either) the upper and lower extremities to pass and (2) requiring only 1 repeat screen instead of 2 for cases that neither pass nor fail initially. The panel underscored the importance of improving public health reporting by further specifying the targets of screening and criteria for reporting outcomes (false-negative and false-positive cases). The panel also highlighted the need to ensure sufficient public health funding for CCHD newborn screening and opportunities for education and global implementation. Newborn screening for CCHD using pulse oximetry has led to significant improvements in child health outcomes. However, further important work is required to understand and improve the effectiveness and efficiency of screening.
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Affiliation(s)
- Gerard R Martin
- Children's National Heart Institute, Children's National Hospital, Washington, District of Columbia;
| | - Andrew K Ewer
- School of Medicine, The George Washington University, Washington, District of Columbia
| | - Amy Gaviglio
- Newborn Screening Program, Minnesota Department of Health, St Paul, Minnesota
| | - Lisa A Hom
- Children's National Heart Institute, Children's National Hospital, Washington, District of Columbia
| | | | - Marci Sontag
- Center for Public Health Innovation, CI International, Littleton, Colorado
| | - Kristin M Burns
- Children's National Heart Institute, Children's National Hospital, Washington, District of Columbia.,School of Medicine, The George Washington University, Washington, District of Columbia.,National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Alex R Kemper
- Division of Ambulatory Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Matthew E Oster
- Children's Healthcare of Atlanta and School of Medicine, Emory University, Atlanta, Georgia; and
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42
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Gómez-Gutiérrez R, Cruz-Camino H, Cantú-Reyna C, Martínez-Cervantes A, Vazquez-Cantu DL, Rivas-Soriano V, Vargas-Betancourt E, Britton-Robles C. Early detection of and intervention for two newborns with critical congenital heart disease using a specialized device as part of a screening system. SAGE Open Med Case Rep 2020; 8:2050313X20926041. [PMID: 32577283 PMCID: PMC7290247 DOI: 10.1177/2050313x20926041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/14/2020] [Indexed: 11/17/2022] Open
Abstract
Screening for critical congenital heart disease is a clinical method used for their early detection using pulse oximetry technology. This, followed by a diagnostic confirmatory protocol, allows timely therapeutic interventions that improve the newborn’s outcome. According to Mexican birth statistics, approximately 18,000–21,000 neonates are born with a form of congenital heart disease each year, of which 25% are estimated to be critical congenital heart disease. We report two cases with an early critical congenital heart disease detection and intervention through an innovative critical congenital heart disease screening program implemented in two Mexican hospitals. They integrated a new automated pulse oximetry data analysis method and a comprehensive follow-up system (Cárdi-k®). Both cases were confirmed by echocardiogram, which served for an intervention in the first week of life, and the patients were discharged in good clinical condition. In addition, to the routine physical assessments, the critical congenital heart disease screening program (which includes echocardiogram for presumptive positive cases) should be implemented in a timely manner.
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Affiliation(s)
- René Gómez-Gutiérrez
- Genomi-k SAPI de CV., Monterrey, Mexico.,Christus Muguerza Hospital Alta Especialidad, Monterrey, Mexico
| | - Héctor Cruz-Camino
- Genomi-k SAPI de CV., Monterrey, Mexico.,Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias de la Salud, Monterrey, Mexico
| | - Consuelo Cantú-Reyna
- Genomi-k SAPI de CV., Monterrey, Mexico.,Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - Adrián Martínez-Cervantes
- Genomi-k SAPI de CV., Monterrey, Mexico.,Christus Muguerza Hospital Conchita, Monterrey, Mexico.,Universidad de Monterrey, Monterrey, Mexico
| | - Diana Laura Vazquez-Cantu
- Genomi-k SAPI de CV., Monterrey, Mexico.,Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - Verónica Rivas-Soriano
- Hospital Médica Sur Lomas, Miguel Hidalgo, Mexico.,Universidad Nacional Autónoma de México, Facultad de Medicina, Coyoacán, Mexico
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43
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Wu W, He J, Shao X. Incidence and mortality trend of congenital heart disease at the global, regional, and national level, 1990-2017. Medicine (Baltimore) 2020; 99:e20593. [PMID: 32502030 PMCID: PMC7306355 DOI: 10.1097/md.0000000000020593] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Congenital heart disease (CHD) is the most commonly diagnosed congenital disorder in newborns. The incidence and mortality of CHD vary worldwide. A detailed understanding of the global, regional, and national distribution of CHD is critical for CHD prevention.We collected the incidence and mortality data of CHD from the Global Burden of Disease study 2017 database. Average annual percentage change was applied to quantify the temporal trends of CHD incidence and mortality at the global, regional, and national level, 1990-2017. A sociodemographic index (SDI) was created for each location based on income per capita, educational attainment, and fertility.The incidence of CHD was relatively high in developing countries located in Africa and Asia, while low in most developed countries. Between 1990 and 2017, the CHD incidence rate remained stable at the global level, whereas increased in certain developed countries, such as Germany and France. The age-standardized mortality rate of CHD declined substantially over the last 3 decades, regardless of sex, age, and SDI region. The decline was more prominent in developed countries. We also detected a significant positive correlation between CHD incidence and CHD mortality in both 1990 and 2017, by SDI.The incidence of CHD remained stable over the last 3 decades, suggesting little improvement in CHD prevention strategies and highlighting the importance of etiological studies. The mortality of CHD decreased worldwide, albeit the greatly geographical heterogeneity. Developing countries located in Africa and Asia deserve more attention and priority in the global CHD prevention program.
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Affiliation(s)
- Weiliang Wu
- Department of Orthopedic Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou
| | - Jinxian He
- Department of Cardiovascular and Thoracic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China
| | - Xiaobo Shao
- Department of Orthopedic Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou
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44
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Bahado-Singh R, Vishweswaraiah S, Mishra NK, Guda C, Radhakrishna U. Placental DNA methylation changes in detection of tetralogy of Fallot. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:768-775. [PMID: 30977211 DOI: 10.1002/uog.20292] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/01/2019] [Accepted: 04/03/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To determine whether the methylation level of cytosine nucleotides in placental DNA can be used to predict tetralogy of Fallot (TOF) and provide insights into the developmental mechanism of this condition. METHODS Tissue sections were obtained from formalin-fixed paraffin-embedded specimens of placental tissue obtained at birth from eight cases with non-chromosomal, non-syndromic TOF and 10 unaffected newborns. The Illumina Infinium HumanMethylation450 BeadChip assay was used to measure cytosine ('CpG' or 'cg') methylation levels at loci throughout the placental genome. Differential methylation was assessed by comparing the β-values (a measure of the extent of cytosine methylation) for individual CpG loci in fetuses with TOF vs in controls. The most discriminating CpG sites were determined based on a preset cut-off of ≥ 2.0-fold change in the methylation level. The predictive accuracy of CpG loci with significant methylation changes for TOF was determined by the area under the receiver-operating-characteristics curve (AUC). A false-discovery-rate (FDR) P-value < 0.05 was used to define a statistically significant difference in the methylation level. Ingenuity Pathway Analysis (IPA) (Qiagen) was used to identify gene pathways that were significantly overexpressed, and thus altered, in TOF cases compared with controls. RESULTS We found a total of 165 significantly differentially methylated CpG loci in TOF cases compared with controls, in 165 separate genes. These biomarkers demonstrated from fair to excellent individual predictive accuracy for TOF detection, with AUCs ≥ 0.75 (FDR P-value < 0.001 for all). The following CpG loci (gene) had the highest predictive accuracy: cg05273049 (ARHGAP22; AUC = 1.00; 95% CI, 1.00-1.00), cg02540011 (CDK5; AUC = 0.96; 95% CI, 0.87-1.00), cg08404201 (TRIM27; AUC = 0.95; 95% CI, 0.84-1.00) and cg00687252 (IER3; AUC = 0.95; 95% CI, 0.84-1.00). IPA revealed over-representation (dysregulation) of 14 gene pathways involved in normal cardiac development, including cardiomyocyte differentiation via bone morphogenetic protein receptors, cardiac hypertrophy signaling and role of nuclear factor of activated T cells in cardiac hypertrophy. Cardiac hypertrophy is an important feature of TOF. CONCLUSIONS Analysis of placental DNA cytosine methylation changes yielded accurate markers for TOF detection and provided mechanistic information on TOF development. Our work appears to confirm the central role of epigenetic changes and of the placenta in the development of TOF. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R Bahado-Singh
- Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - S Vishweswaraiah
- Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - N K Mishra
- Department of Genetics, Cell Biology & Anatomy College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - C Guda
- Department of Genetics, Cell Biology & Anatomy College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - U Radhakrishna
- Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
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45
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Krishna MR, Kumar RK. Diagnosis and Management of Critical Congenital Heart Diseases in the Newborn. Indian J Pediatr 2020; 87:365-371. [PMID: 31989462 DOI: 10.1007/s12098-019-03163-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 12/18/2019] [Indexed: 12/17/2022]
Abstract
Congenital heart disease (CHD) has been one of the most important contributors to neonatal mortality in the western world for the past 2 decades. With improvement in basic neonatal medical care in most parts of our country, the traditional contributors to neonatal mortality such as birth asphyxia and infections have reduced in numbers. This has hence thrust greater focus on CHD. Facilities with capability to diagnose and intervene on neonates with critical CHD are available in most states. Refinements in surgical techniques and advances in post-operative care have ensured that most neonates with critical CHD can undergo surgical or interventional procedures with very low mortality and can be expected to survive to adulthood with a reasonable quality of life. Unrecognized critical CHD could however result in death in the neonatal period. Focus has hence shifted towards sensitizing pediatricians about timely recognition of neonates with CHD. In this article, authors discuss the presentation and initial stabilization of neonates with CHD and attempt to provide practical solutions which can aid early diagnosis of CHD in the Indian scenario.
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Affiliation(s)
- Mani Ram Krishna
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, 682041, India.
| | - Raman Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, 682041, India
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46
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AlAql F, Khaleel H, Peter V. Universal Screening for CCHD in Saudi Arabia: The Road to a 'State of the Art' Program. Int J Neonatal Screen 2020; 6:13. [PMID: 33073011 PMCID: PMC7422967 DOI: 10.3390/ijns6010013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/23/2020] [Indexed: 11/17/2022] Open
Abstract
Critical congenital heart disease (CCHD) has been defined as structural heart defects that are usually associated with hypoxia in the newborn period and have potential for significant morbidity and mortality early in life. CCHD has been estimated to be present in ∼3 in 1000 live births, including Saudi Arabia. Pulse Oximetry Screening (POS) is a highly specific and moderately sensitive test for detecting CCHD with very low false-positive rates. The Kingdom of Saudi Arabia is among high-income countries with a population of more than 33 million and more than 600,000 annual live births. In 2015, the Universal Screening Program for CCHD using Pulse Oximetry was approved in Saudi Arabia. It is expected that any new national program will undergo a learning curve and face many challenges. We believe that developing countries may face different challenges during implementation of such national projects, but the success achieved by Saudi Arabia in implementing the program was mainly due to good preparation before launching the project and advancements in the use of the technology involved in this project. Since starting the universal CCHD screening in 2016, more than 900,000 babies have been screened in Saudi Arabia and many lives have been saved using this safe, non-invasive, inexpensive, and reasonably sensitive test.
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Affiliation(s)
- Fahad AlAql
- Neonatal Services Improvement Program, Ministry of Health (MOH), Riyadh 11525, Saudi Arabia;
| | - Huda Khaleel
- Pediatric Cardiology Department, Heart Health Center, KSMC, Riyadh 12748, Saudi Arabia;
| | - Vetha Peter
- Neonatal Services Improvement Program, Ministry of Health (MOH), Riyadh 11525, Saudi Arabia;
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47
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Cloete E, Gentles TL, Webster DR, Davidkova S, Dixon LA, Alsweiler JM, Bloomfield FH. Pulse oximetry screening in a midwifery-led maternity setting with high antenatal detection of congenital heart disease. Acta Paediatr 2020; 109:100-108. [PMID: 31298757 PMCID: PMC6972617 DOI: 10.1111/apa.14934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/14/2019] [Accepted: 07/09/2019] [Indexed: 01/29/2023]
Abstract
Aim To assess local and individual factors that should be considered in the design of a pulse oximetry screening strategy in New Zealand's midwifery‐led maternity setting. Methods An intervention study was conducted over 2 years. Three hospitals and four primary maternity units participated in the study. Post‐ductal saturation levels were measured on well infants with a gestation of ≥35 weeks. Infant activity and age (hours) at the time of the test were recorded. Results Screening was performed on 16 644 of 27 172 (61%) eligible infants. The age at which the screening algorithm was initiated varied significantly among centres. The probability of achieving a pass result (saturations ≥95%) in the context of no underlying pathology ranged from .94 for an unsettled infant screened <4 hours of age to .99 (P < .001) when the test was performed after 24 hours on a settled infant. Forty‐eight (0.3%) infants failed to reach saturation targets: 37 had significant pathology of which three had cardiac disease. Conclusion Screening practices were influenced by the setting in which it was undertaken. Infant activity and age at the time of testing can influence saturation levels. Screening is associated with the identification of significant non‐cardiac pathology.
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Affiliation(s)
- Elza Cloete
- Liggins Institute University of Auckland Auckland New Zealand
| | - Thomas L. Gentles
- Paediatric and Congenital Cardiac Services Starship Children's Hospital Auckland New Zealand
| | - Dianne R. Webster
- Newborn Metabolic Screening Unit Auckland City Hospital Auckland New Zealand
| | - Sarka Davidkova
- Department of Paediatrics Rotorua Hospital Rotorua New Zealand
| | | | - Jane M. Alsweiler
- Department of Paediatrics, Child and Youth Health University of Auckland Auckland New Zealand
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Affiliation(s)
- Viviane G Nasr
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - James A DiNardo
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
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49
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Hoffman JIE. False negative diagnoses of critical congenital heart disease with screening neonatal pulse oximetry. J Neonatal Perinatal Med 2019; 13:5-9. [PMID: 31594260 DOI: 10.3233/npm-190297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND False negative pulse oximeter results occur in new born infants with critical congenital heart disease who have an oximeter saturation ≥95%. Some of these infants have abnormal physical findings but others do not. OBJECTIVES To determine the causes of false negative results. METHODS Mathematical analysis of determinants of arterial oxygen saturation and discussion of oximeter bias. RESULTS False negative oximeter results are not rare; the sensitivity of pulse oximetry screening for critical congenital heart disease is about 80%. The high saturation may be due to a very small right-to-left shunt at the time of study, a relatively high cardiac output and mixed venous saturation, or to positive bias in oximeter readings. It may also be due to some critical congenital heart lesions that do not show desaturation at the time of testing. CONCLUSIONS A diagnosis of a normal heart based on a negative oximeter test is presumptive, and requires careful follow-up for 1-2 weeks after birth.
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Affiliation(s)
- J I E Hoffman
- Department of Pediatrics, University of California, San Francisco, CA, USA
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50
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Badawi D, Watson J, Maschke S, Reid L. First-Year Outcomes of Critical Congenital Heart Disease Screening in Maryland. Glob Pediatr Health 2019; 6:2333794X19868226. [PMID: 31453268 PMCID: PMC6700861 DOI: 10.1177/2333794x19868226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/23/2019] [Accepted: 06/28/2019] [Indexed: 11/17/2022] Open
Abstract
Objectives. Newborn screening for critical congenital heart disease (CCHD) was added to the Recommended Uniform Screening Panel in 2011, and states have been gradually adding pulse oximetry as point-of-care screening to panels. Few data are available on the effectiveness of pulse oximetry as a mandated screening. This study describes outcomes of the first year of screening in Maryland. Methods. A web-based data collection tool for screening results and outcomes, eScreener Plus, was utilized. Data collected from the start of screening from September 1, 2012, to December 31, 2013, were analyzed. Well-baby nursery data were evaluated separately from neonatal intensive care unit (NICU) data to determine whether setting influenced effectiveness. Results. In the first 15 months of newborn screening for CCHD in Maryland, 4 asymptomatic infants were diagnosed with a critical cardiac condition by newborn screening. Eleven infants passed but were later identified with a primary or secondary target condition. Seventy-one percent of infants with CCHD were identified prenatally or by clinical signs and symptoms. Pulse oximetry screening for CCHD had a specificity of more than 99% in both the well-baby nursery and the NICU. Sensitivity in the well-baby nursery was 10% and 60% in the NICU. Conclusion. Further investigation and interpretation of specific protocols that were used and outcomes of screening is needed for continued refinement of the well-baby algorithm and NICU protocol development. Pulse oximetry screening in newborns provides valuable clinical information, but many infants with CCHD are still not identified with current protocols.
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