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Should we start a nationwide screening program for critical congenital heart disease in Turkey? A pilot study on four centres with different altitudes

Published online by Cambridge University Press:  08 April 2019

Dilek Dilli*
Affiliation:
Neonatology Department, Health Science University, Dr Sami Ulus Research and Application Center, Ankara, Turkey
Vehbi Doğan
Affiliation:
Pediatric Cardiology Department, Health Science University, Dr Sami Ulus Research and Application Center, Ankara, Turkey
Banu M. Özyurt
Affiliation:
Neonatology Department, Mersin Maternity and Children Hospital, Mersin, Turkey
Abdullah Özyurt
Affiliation:
Pediatric Cardiology Department, Mersin Maternity and Children Hospital, Mersin, Turkey
Nilay Hakan
Affiliation:
Neonatology Department, Muğla Sıtkı Koçman University, Muğla, Turkey
Sibel Bozabalı
Affiliation:
Pediatric Cardiology Department, Muğla Sıtkı Koçman University, Muğla, Turkey
İbrahim Caner
Affiliation:
Neonatology Department, Atatürk University, Erzurum, Turkey
Haşim Olgun
Affiliation:
Pediatric Cardiology Department, Atatürk University, Erzurum, Turkey
Murat Koç
Affiliation:
Pediatric Cardiovascular Surgery Department, Health Science University, Dr Sami Ulus Research and Application Center, Ankara, Turkey
İrfan Taşoğlu
Affiliation:
Pediatric Cardiovascular Surgery Department, Turkiye Yuksek İhtisas Training and Research Hospital, Ankara, Turkey
Selmin Karademir
Affiliation:
Pediatric Cardiology Department, Health Science University, Dr Sami Ulus Research and Application Center, Ankara, Turkey
Ayşegül Zenciroğlu
Affiliation:
Neonatology Department, Health Science University, Dr Sami Ulus Research and Application Center, Ankara, Turkey
*
Author for correspondence: Dilek Dilli, MD, Associate Professor, Health Science University, Dr Sami Ulus Research and Application Center, Ankara, Turkey. Tel: + 90 312 4123208; Fax: +3124123056013; E- mail: dilekdilli2@yahoo.com

Abstract

Background:

To investigate the feasibility of critical congenital heart disease (CCHD) screening test by pulse oximetry in four geographical regions of Turkey with different altitudes, before implementation of a nationwide screening program.

Methods:

It was a prospective multi-centre study performed in four centres, between December, 2015 and May, 2017. Pre- and post-ductal oxygen saturations and perfusion indices (PI) were measured using Masimo Radical-7 at early postnatal days. The results were evaluated according to the algorithm recommended by the American Academy of Pediatrics. Additionally, a PI value <0.7 was accepted to be significant.

Results:

In 4888 newborns, the mean screening time was 31.5 ± 12.1 hours. At first attempt, the mean values of pre- and post-ductal measurements were: saturation 97.3 ± 1.8%, PI 2.8 ± 2.0, versus saturation 97.7 ± 1.8%, PI 2.3±1.3, respectively. Pre-ductal saturations and PI and post-ductal saturations were the lowest in Centre 4 with the highest altitude. Overall test positivity rate was 0.85% (n = 42). CCHD was detected in six babies (0.12%). Of them, right hand (91 ± 6.3) and foot saturations (92.1 ± 4.3%) were lower compared to ones with non-CCHD and normal variants (p <0.05, for all comparisons). Sensitivity, specificity, positive and negative predictive values, and likelihood ratio of the test were: 83.3%, 99.9%, 11.9%, 99.9%, and 99.2%, respectively.

Conclusion:

This study concluded that pulse oximetry screening is an effective screening tool for congenital heart disease in newborns at different altitudes. We support the implementation of a national screening program with consideration of altitude differences for our country.

Type
Original Article
Copyright
© Cambridge University Press 2019 

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References

Frank, LH, Bradshaw, E, Beekman, R, et al. Critical congenital heart disease screening using pulse oximetry. J Pediatr 2013; 162: 445453.CrossRefGoogle ScholarPubMed
Wren, C, Reinhardt, Z, Khawaja, K. Twenty-year trends in diagnosis of life-threatening neonatal cardiovascular malformations. Arch Dis Child Fetal Neonatal Ed 2008; 93: F33F35.CrossRefGoogle ScholarPubMed
de-Wahl Granelli, A, Wennergren, M, Sandberg, K, et al. Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: a Swedish prospective screening study in 39, 821 newborns. BMJ 2009; 338: 3037.CrossRefGoogle ScholarPubMed
Abu-Harb, M, Hey, E, Wren, C. Death in infancy from unrecognized congenital heart disease. Arch Dis Child 1994; 71: 37.CrossRefGoogle Scholar
Hoffman, JI. It is time for routine neonatal screening by pulse oximetry. Neonatology 2011; 99: 19.CrossRefGoogle ScholarPubMed
Kemper, AR, Mahle, WT, Martin, GR, et al. Strategies for implementing screening for critical congenital heart disease. Pediatrics 2011; 128: 12591267.CrossRefGoogle ScholarPubMed
Ewer, AK. Screening for critical congenital heart defects with pulse oximetry: medical aspects. Am J Perinatol 2016; 33: 10621066.Google ScholarPubMed
Meberg, A, Brugmann-Pieper, S, Due, R Jr, et al. First day of life pulse oximetry screening to detect congenital heart defects. J Pediatr 2008; 152: 761765.CrossRefGoogle ScholarPubMed
Riede, FT, Worner, C, Dahnert, I, et al. Effectiveness of neonatal pulse oximetry screening for detection of critical congenital heart disease in daily clinical routine – results from a prospective multicentre study. Eur J Pediatr 2010; 169: 975981.CrossRefGoogle Scholar
Thangaratinam, S, Brown, K, Zamora, J, et al. Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: a systematic review and metaanalysis. Lancet 2012; 379: 24592464.CrossRefGoogle Scholar
Zhao, QM, Ma, XJ, Ge, XL, et al. Pulse oximetry with clinical assessment to screen for congenital heart disease in neonates in China: a prospective study. Lancet 2014; 384: 747754. Erratum in: Lancet. 2014; 384:746.CrossRefGoogle ScholarPubMed
Samuel, TY, Bromiker, R, Mimouni, FB, et al. Newborn oxygen saturation at mild altitude versus sea level: implications for neonatal screening for critical congenital heart disease. Acta Paediatr 2013; 102: 379384.CrossRefGoogle ScholarPubMed
Thilo, EH, Park-Moore, B, Berman, ER, Carson, BS. Oxygen saturation by pulse oximetry in healthy infants at an altitude of 1610 m (5280 ft). What is normal? Am J Dis Child 1991; 145: 11371140.CrossRefGoogle Scholar
Wright, J, Kohn, M, Niermeyer, S, Rausch, CM. Feasibility of critical congenital heart disease newborn screening at at moderate altitude. Pediatrics 2014; 133: e561e569.CrossRefGoogle ScholarPubMed
Miao, CY, Zuberbuhler, JS, Zuberbuhler, JR. Prevalence of congenital cardiac anomalies at high altitude. J Am Coll Cardiol 1988; 12: 224228.CrossRefGoogle ScholarPubMed
Albuquerque, FC, Maia, ET, Figueiredo, VL, Mourato, FA, Mattos, SS Clinical examination and pulse oximetry to detect congenital heart defects. Int J Cardiovasc Sci 2015; 28: 148151.Google Scholar
Mathur, NB, Gupta, A, Kurien, S. Pulse oximetry screening to detect cyanotic congenital heart disease in sick neonates in a neonatal intensive care unit. Indian Paediatr 2015; 52: 769772.CrossRefGoogle Scholar
Ainsworth, SB, Wyllie, JP, Wren, C. Prevalence and clinical significance of cardiac murmurs in neonates. Arch Dis Child 1999; 80: F43F45.CrossRefGoogle ScholarPubMed
Mellander, M, Sunnegardh, J. Failure to diagnose critical heart malformations in newborns before discharge – an increasing problem? Acta Paediatr 2006; 95: 407413.CrossRefGoogle ScholarPubMed
de-Wahl Granelli, A, Ostman-Smith, I. Noninvasive peripheral perfusion index as a possible tool for screening for critical left heart obstruction. Acta Paediatr 2007; 96: 14551459.CrossRefGoogle Scholar
Turska Kmiec´, A, Borszewska Kornacka, MK, Błaz, W, et al. Early screening for critical congenital heart defects in asymptomatic newborns in Mazovia province: experience of the POLKARD pulse oximetry programme 2006–2008 in Poland. Kardiol Pol 2012; 70: 370376.Google ScholarPubMed
Vaidyanathan, B, Sathish, G, Mohanan, ST, et al. Clinical screening for congenital heart disease at birth: a prospective study in a community hospital in Kerala. Indian Pediatr 2011; 48: 2530.CrossRefGoogle Scholar
Koppel, RI, Druschel, CM, Carter, T, et al. Effectiveness of pulse oximetry screening for congenital heart disease in asymptomatic newborns. Pediatrics 2003; 111: 451455.CrossRefGoogle ScholarPubMed
Arlettaz, R, Bauschatz, AS, Monkhoff, M, et al. The contribution of pulse oximetry to the early detection of congenital heart disease in newborns. Eur J Pediatr 2006; 165: 9498.CrossRefGoogle ScholarPubMed
Richmond, S, Reay, G, AbuHarb, M. Routine pulse oximetry in the asymptomatic newborn. Arch Dis Child Fetal Neonatal Ed 2002; 87: F83F88.CrossRefGoogle ScholarPubMed
Ozalkaya, E, Akdağ, A, Sen, I, et al. Early screening for critical congenital heart defects in asymptomatic newborns in Bursa province. J Matern Fetal Neonatal Med 2016; 29: 11051107.CrossRefGoogle ScholarPubMed
Diller, CL, Kelleman, MS, Kupke, KG, Quary, SC, Kochilas, LK, Oster, ME. A modified algorithm for critical congenital heart disease screening using pulse oximetry. Pediatrics 2018 May; 141: pii: e20174065. doi: 10.1542/peds.2017-4065.CrossRefGoogle ScholarPubMed
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