Perfusion Index and Pulse Oximetry Screening for Congenital Heart Defects.

Autor: Schena F; Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione Cà Granda Ospedale Maggiore Policlinico, University of Milan, Italy. Electronic address: federico.schena@mangiagalli.it., Picciolli I; Neonatal Intensive Care Unit, Ospedale M. Melloni ASST Fatebenefratelli Sacco, Milan, Italy., Agosti M; Maternal and Child Health Department, Del Ponte Hospital, A.O. Di Circolo Fondazione Macchi, Varese, Italy., Zuppa AA; Department of Neonatology, Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy., Zuccotti G; Department of Pediatrics, University of Milan, Ospedale dei Bambini V. Buzzi, Milan, Italy., Parola L; Department of Pediatrics and Neonatology, Magenta Hospital AO Ospedale Civile di Legnano, Magenta, Italy., Pomero G; Neonatology and Neonatal Intensive Care Unit, ASO St Croce and Carle Hospital, Cuneo, Italy., Stival G; Department of Pediatrics and Neonatology, SS Trinità Hospital Borgomanero, Novara, Italy., Markart M; Department of Pediatrics, Bressanone Hospital, Brixen, Italy., Graziani S; Department of Neonatology, S. Chiara Hospital, Apss Trento, Italy., Gagliardi L; Woman and Child Health Department, Pediatric and Neonatology Division, Ospedale della Versilia, Viareggio, Italy., Bellan C; Department of Neonatology, Bolognini Hospital, Seriate, Bergamo, Italy., La Placa S; Department of Sciences for Health Promotion and Mother and Child Care Giuseppe D'Alessandro, University of Palermo, Palermo, Italy., Limoli G; Department of Pediatrics, Lodi Hospital, Lodi, Italy., Calzetti G; Neonatal Intensive Care Unit, Carlo Poma Hospital, Mantova, Italy., Guala A; Departement of Pediatrics, Castelli Hospital, Verbania, Italy., Bonello E; Neonatal Intensive Care Unit, S Antonio Abate Hospital, Trapani, Italy., Mosca F; Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione Cà Granda Ospedale Maggiore Policlinico, University of Milan, Italy.
Jazyk: angličtina
Zdroj: The Journal of pediatrics [J Pediatr] 2017 Apr; Vol. 183, pp. 74-79.e1. Date of Electronic Publication: 2017 Jan 30.
DOI: 10.1016/j.jpeds.2016.12.076
Abstrakt: Objective: To evaluate the efficacy of combined pulse oximetry (POX) and perfusion index (PI) neonatal screening for severe congenital heart defects (sCHD) and assess different impacts of screening in tertiary and nontertiary hospitals.
Study Design: A multicenter, prospective study in 10 tertiary and 6 nontertiary maternity hospitals. A total of 42 169 asymptomatic newborns from among 50 244 neonates were screened; exclusion criteria were antenatal sCHD diagnosis, postnatal clinically suspected sCHD, and neonatal intensive care unit admission. Eligible infants underwent pre- and postductal POX and PI screening after routine discharge examination. Targeted sCHD were anatomically defined. Positivity was defined as postductal oxygen saturation (SpO 2 ) ≤95%, prepostductal SpO 2 gradient >3%, or PI <0.90. Confirmed positive cases underwent echocardiography for definitive diagnosis. Missed cases were identified by consulting clinical registries at 6 regional pediatric heart centers. Main outcomes were incidence of unexpected sCHD; proportion of undetected sCHD after discharge in tertiary and nontertiary hospitals; and specificity, sensitivity, positive predictive value, and negative predictive value of combined screening.
Results: One hundred forty-two sCHD were detected prenatally. Prevalence of unexpected sCHD was 1 in 1115 live births, similar in tertiary and nontertiary hospitals. Screening identified 3 sCHD (low SpO 2 , 2; coarctation for low PI, 1). Four cases were missed. In tertiary hospitals, 95% of unsuspected sCHDs were identified clinically, whereas only 28% in nontertiary units; in nontertiary units PI-POX screening increased the detection rate to 71%.
Conclusions: PI-POX predischarge screening provided benefits in nontertiary units, where clinical recognition rate was low. PI can help identify coarctation cases missed by POX but requires further evaluation in populations with higher rates of missed cases.
(Copyright © 2017 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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