Lessons Learned from Infants with Late Detection of Critical Congenital Heart Disease.
Autor: | Martin GR; Division of Cardiology and The Children's National Heart Institute, Children's National Hospital, 111 Michigan Avenue, N.W., Washington, D.C., 20010, USA. gmartin@childrensnational.org.; The George Washington School of Medicine, Washington, D.C., USA. gmartin@childrensnational.org., Schwartz BN; 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., Hom LA; 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., Donofrio MT; 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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Jazyk: | angličtina |
Zdroj: | Pediatric cardiology [Pediatr Cardiol] 2022 Mar; Vol. 43 (3), pp. 580-585. Date of Electronic Publication: 2021 Oct 28. |
DOI: | 10.1007/s00246-021-02760-5 |
Abstrakt: | 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. (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.) |
Databáze: | MEDLINE |
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