Prevention and Early Detection of Congenital Heart Defects. Where do we stand (original) (raw)
Related papers
Right use of Screening Pulse Oximetry test for early detection of Critical Congenital Heart Diseases
EURASIAN JOURNAL OF CLINICAL SCIENCES
Introduction: Preventive medicine is the ideal way in dealing with frequent and fatal diseases. Congenital heart disease (CHD) is responsible for the largest proportion of mortality caused by birth defects in the first year of life. Actual numbers and mortality from CHD is increasing. In the developed world the treatment of CHD has escalating costs for health care systems and private covered patients, while in low-income countries the resources are minimal. Prevention/early detection is urgently needed to tackle the increasing needs. Aim: To justify why pulse oximetry (pox) is the best available, early detecting postnatal screening test currently. Conclusion: Although CHD’s are both frequent and carry a high morbidity and mortality, we still lack a single, easy to apply, non-invasive and low-cost screening test, worldwide. The most advantageous method for minimizing CHD deaths worldwide seems to be currently, the combination of clinical assessment with pox. Original publication: htt...
Asian Journal of Clinical Pediatrics and Neonatology, 2019
Background: This study was designed to evaluate the effectiveness of routine postnatal clinical examination and pulse oximetry screening in detecting congenital heart disease in new-borns. Subjects and Methods: The term newborn babies born in narayana medical college and Hospital during the study period of 12months had a thorough clinical examination on day 2 of life with emphasis on peripheral pulses, cyanosis, tachypnea, cardiac pulsations and murmurs. Pulse oximetry screening was done within 4hrs of birth and at 48-72hrs of life. Chest X-ray, ECG and Echocardiogram were done for those babies with either abnormal clinical examination or pulse oximetry reading. Clinical examination was done again 2 weeks after discharge. Results: The sensitivity 26% for oximetry alone and 60% for clinical examination alone. Specificity was 99.8% for pulse oximetry alone, and 98% for clinical examination alone. Conclusion: Pulse oximetry can enhance the clinician's ability to detect life threatening CHD in a timely manner.
Sohag Medical Journal, 2018
Background: Cardiovascular malformations are the commonest form of congenital defects and could result in significant morbidity. Antenatal and early postnatal detection is still unreliable, especially in developing countries and low-income communities. Pulse oximetry (PO) could have an important value in the detection of cardiac lesions among asymptomatic newborns. Patients and methods:This was prospective observational study conducted at nursery units at Sohag university hospital and Sohag general hospital. Over a period of one year, the period from October 2016 through October 2017. Oxygen saturation was measured by pulse oxymetery. Echocardiography was done for babies with positive screening within 24h of screening Results: The study included 830 apparently-well babies, there were 25 babies (3%) show positive screening. Sensitivity of POS for CHD was 88.64% .The specificity was 91.67%. The false-positive rate was 4%, a positive predictive value (PPV) of 92%, a negative predictive value (NPV) of 88%. Conclusion: Pulse oximetry screening (POS) was found to be safe, simple, noninvasive, reasonably accurate, effective, and has high specificity for early diagnosis of CHD in apparently healthy newborns in our locality.
Pulse Oximetry and Congenital Heart Disease Screening: Results of the First Pilot Study in Morocco
International Journal of Neonatal Screening
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%):...
Screening for Critical Congenital Heart Disease in Thai Neonates : Single center study
2013
Introduction Congenital cardiovascular malformation is one of the leading causes of infant death. The incidence is variable from 4/1000 to 50/1000 live births depend on the facilities to detect trivial lesions in each studies1. About 1⁄4 of them had severe clinical presentation requiring surgical or catheter intervention during neonatal period2,3, classified to Critical Congenital Heart Disease (cCHD) group such as Hypoplastic left heart Background : Pulse oximetry is widely used to early detect the Critical Congenital Heart Diseases (CCHD). Intervention prior end organs damage can improve survival rate and shorter duration in intensive care unit. Objectives : To initiate the screening program for critical congenital heart diseases in neonates who born at Ratchaburi hospital and study the incidence and efficacy of Pulse oximetry screening in this population. Patients and Methods : A prospective study was done between July 1, 2011 and April 30, 2013 in postpartum units and intermedia...
Early detection of critical congenital heart disease in new borns using pulse oximetry screening
Background: Congenital heart diseases which are dependent on the ductusarteriosus to maintain adequate oxygenation or systemic blood flow are termed as a critical congenital heart disease (CCHD). Delay in the diagnosis of CCHD is the major cause leading to morbidity and mortality in newborn infants. Clinical evaluation is likely to miss the diagnosis in first few hours of hospital stay after birth due to absence of signs and symptoms of CCHD.In the absence of clinical findings during early neonatal period, the best parameter that can be assessed is the detection of hypoxemia by pulse oximetry screening. Objectives: To record the value of Pulse Oximetry within 24 hours of birth and evaluate Pulse Oximetry as screening tool for early diagnosis of CCHD. Methods: Longitudinal descriptive study was conducted on total 700 intramural neonates, satisfying the inclusion and exclusion criteria, who were evaluated within 24 hours of birth with currently available pulse oximeter, after the Institutional Ethical Committee approval. The study was conducted over a period of 4 months. Part-A: Neonatal Case Record, Part-B: Pulse Oximetry Screening Record, Part-C: Clinical Examination Record, Part-D: Echocardiography Record. Results and Conclusion: Total 700 neonates were screened by pulse oximeter with consecutive sampling method. 4 (0.57%) subjects were detected to have positive screen and the diagnosis was confirmed by echocardiography. Study revealed that Pulse Oximetry Screening can be an important primary screening tool in routine neonatal care for early detection of Critical Congenital Heart Diseases particularly in rural setup.
Sri Lanka Journal of Child Health
Background: Critical congenital heart disease (CCHD) constitutes a spectrum of different heart anomalies needing intervention early in life for survival. Pulse oximetry screening (POS) claims to have a sensitivity of 60%, specificity of 99.95%, positive predictive value (PPV) of 75% and a negative predictive value (NPV) of 99.98% in detecting CCHD. Objectives: To assess the effectiveness of POS in identifying CCHD in a tertiary care neonatal unit in Sri Lanka. Method: A prospective descriptive study was carried out at Sri Jayewardenepura General Hospital (SJGH) from October 2017 to March 2020 including all healthy newborns delivered at SJGH. Babies with a prenatal diagnosis of CHD and those who needed admission to neonatal unit before POS was performed were excluded. Recruited babies underwent POS after 24 hours, but before 48 hours of life, in addition to routine newborn examination. Results: There were 8964 live births during the study period. POS was carried out in 8718 babies and was positive in 19 babies; 18 babies had CHD confirmed by echocardiogram, out of which 14 had CCHD. Hence, the incidence of CCHD, identified by POS was 1.56 per 1000 live births. Furthermore, POS demonstrated a PPV of 73.7%, and a false positive rate of 0.06%.
SAGE Open Medical Case Reports, 2020
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 ass...
Use of Pulse Oximeter as a Tool in Screening of Critical Congenital Heart Disease in Newborn
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Among all congenital malformations, congenital heart disease is relatively a common problem with incidence of 6-8 in every 1000 live births. Of this, 25% will have critical congenital heart disease. Congenital heart disease accounts for about 10% of the infant deaths. Nowadays, even complex congenital heart diseases can be treated with the appropriate surgical or catheter intervention. Early diagnosis of congenital heart disease is important for good clinical outcome. Unrecognised or delayed diagnosis of some severe congenital heart diseases can lead to cardiac failure, cardiovascular collapse and even death. There is need for effective screening programme for early detection of congenital heart disease. This disease is ideally suited for screening program if simple and reliable methods were available. Pulse oximetry is one such tool, which can be used as a screening tool for detection of critical congenital heart diseases in asymptomatic newborns. MATERIALS AND METHODS This study is a hospital-based prospective study. In this study, we screened asymptomatic term newborn babies in the postnatal ward for cyanotic congenital heart disease by pulse oximetry using Mindray PM-60 hand-held Pulse Oximeter and detailed clinical examination was done. Babies were screened at 12 hours and 48 hours of post-natal life. Asymptomatic term newborn babies were screened by pulse oximetry. Pulse oximetry was conducted on a quiet, sleeping newborn baby and recorded in all four extremities. The probe was cleansed with alcohol swab before each use. The same pulse oximeter was used for all subjects of this study. The functional oxygen saturation of 95% was accepted as normal, if the readings fall below 95% in any of the limbs. They are subjected to echocardiography to detect cardiac defects. RESULTS We screened a total of 2015 newborn babies with pulse oximetry to detect Critical Congenital Heart Disease (CCHD). In this study, abnormal pulse oximetry was found in 17 babies found to have congenital heart disease, out of which 3 cases were Critical Congenital Heart Disease (CCHD), all cases were confirmed on echocardiography. CONCLUSION This study indicates that pulse oximetry is a non-invasive, reliable, cost effective and useful screening tool for detection of Critical Congenital Heart Disease (CCHD). In addition to prenatal ultrasound and routine examination, further screening with pulse oximetry is warranted to improve early detection of critical congenital heart disease. Detection of cardiac murmur may be a clue to the presence of any underlying heart disease, particularly in asymptomatic newborn, though in majority of the babies the murmur detected on 1 st day may not be sustainable or significant. Absence of cyanosis does not rule out critical congenital heart disease. This study suggests that the combination of pulse oximetry and clinical examination results in early detection of critical congenital heart disease. Pulse oximetry has an additive effect and results in more efficient screening, hence it should be used as a screening method for detection of critical congenital heart disease.
European Journal of Pediatrics, 2014
Pulse oximetry has been recommended for neonatal screening for critical congenital heart defects (CCHD) and is now performed in several countries where most births take place in hospital. However, there is a wide variation in perinatal care in European countries, and studies are now recommended to determine the accuracy and cost-effectiveness of CCHD screening in individual countries. In the Netherlands, a large part of births are supervised by a community-based midwife, at home or at policlinics. A screening protocol has been developed to fit into the Dutch perinatal setting, and also has the potential to increase safety in homebirths. Conclusion: the provided protocol might be useful for other countries that are planning to implement CCHD screening after homebirths or early discharge from hospital.