Our screening results for critical congenital heart disease in newborns

Yıl 2022, Cilt: 9 Sayı: 1, 71 - 75, 31.03.2022

Sema Tanrıverdi , Sinem Atik Coşkun Şenol

https://doi.org/10.34087/cbusbed.985651

Cited By: 1

Öz

Objective: Congenital heart disease (CHD) is the most common congenital disease. Critical congenital heart disease (CCHD) is CHD that requires surgery or catheterization in the first 28 days of life. Mortality and morbidity increase in cases with delayed diagnosis of CCHD after birth. In this study, it was aimed to evaluate the results of CHD screening with pulse oximetry applied before discharge in our hospital.
Materials and Methods: 504 newborn babies born in our hospital and followed up with their mothers between January 2019 and January 2020 were included in the study. Babies who were diagnosed with CHD in the prenatal period or who hadmajor anomalies other than CHD were not included in the study. Before discharge, preductal and postductal saturation measurements were made with pulse oximetry.
Results: A total of 504 infants were included in the study. The mean birth week of the babies was 38.27 ± 1.35 (35-42) weeks, and the birth weight was 3200.29 ± 476.05 (1980-4970). female/male ratio 250/254; cesarean/normal delivery rate was 337/167. The mean age of the infants at the time of screening was 32.51 ± 17.87 (6-96) hours. As a result of scanning, mean cardiac pulse is 140.06 ± 15.03 (99-186) / min, preductal saturation value is 97.66% ± 1.92 (89-100), postductal saturation value is 97.88 ± 1.84 (90%) -100), the difference was 1.49 ± 1.40 (0-7). While 85 (16.9%) babies remained from the first screening, 56 (11.1%) of 85 babies who were screened after the second screening remained. Pathology was detected in 45 of 72 infants who underwent ECHO after screening and physical examination, and it was evaluated as normal in 27. CCHD was not detected in any of the patients.
Conclusion: We evaluated our CCHD screening results with pulse oximetry, which is also performed in many centers. In the evaluation, CCHD was not detected in any of the patients who failed the screening test. This was thought to be due to regular perinatal follow-up and detailed ultrasonographic evaluation.

Anahtar Kelimeler

Newborn screening, Congenital heart disease, Pulse oximetry

Yenidoğanlarda kritik konjenital kalp hastalığı tarama sonuçlarımız

Öz

Giriş ve Amaç: Konjenital kalp hastalığı (KKH), en sık görülen konjenital hastalıktır. Kritik konjenital kalp hastalığı (KKKH) ise, yaşamın ilk 28 gününde cerrahi operasyon ya da kateter girişimi gereksinimi olan KKH’dır. Doğumdan sonra KKKH tanısı geciken vakalarda mortalite ve morbidite artar. Bu çalışmada hastanemizde taburculuk öncesi uygulanan nabız oksimetre ile KKKH taraması sonuçlarının değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntemler: Ocak 2019 ile Ocak 2020 tarihleri arasında hastanemizde doğan ve anne yanında takip edilen 504 yenidoğan bebek çalışmaya dahil edildi. Prenatal dönemde KKKH tanısı almış ya da KKH dışı major anomalisi olan bebekler çalışmaya dahil edilmedi. Taburculuk öncesi nabız oksimetre ile preduktal ve postduktal saturasyon ölçümleri yapıldı.
Bulgular: Çalışmaya toplam 504 bebek alındı. Bebeklerin ortalama doğum haftası 38,27 ± 1,35 (35-42) hafta, doğum ağırlığı ise 3200,29 ± 476,05 (1980-4970) olarak saptandı. Kız/erkek oranı 250/254; sezeryan/normal doğum oranı 337/167 idi. Tarama sırasındaki bebeklerin ortalama yaşları 32,51 ± 17,87 (6-96) saatti. Tarama sonucu ortalama kardiak nabız 140,06 ± 15,03 (99-186) /dk, preduktal saturasyon değeri %97,66 ± 1,92 (89-100), postduktal saturasyon değeri %97,88 ± 1,84 (90-100), fark %1,49 ± 1,40 (0-7) olarak saptandı. İlk taramadan 85 (%16,9) bebek kalırken, ikinci tarama yapılan 85 bebeğin 56 (%11,1)’sı kaldı. Tarama ve fizik muayene sonrası EKO’su yapılan 72 bebeğin 45inde patoloji saptanırken 27’sinde normal olarak değerlendirildi. Hiç bir hastada KKKH saptanmadı.
Sonuç: Birçok merkezde de yapılan nabız oksimetre ile KKKH tarama sonuçlarımızı değerlendirdik. Yapılan değerlendirmede tarama testinden kalan hastaların hiçbirinde KKKH saptanmadı. Bunun da düzenli perinatal takip ve ayrıntılı ultrasonografik değerlendirmeye bağlı olduğu düşünüldü.

Anahtar Kelimeler

Yenidoğan taraması, Konjenital kalp hastalığı, Nabız oksimetre

Kaynakça

• Tennant, P.W, Pearce, M.S, Bythell, M, Rankin, J, 20-year survival of children born with congenital anomalies: a population-based study, Lancet, 2010, 375(9715): 649-656.
• Bird, T.M, Hobbs, C.A, Cleves, M.A, et al., National rates of birth defects among hospitalized newborns, Birth Defects Research Part A Clinical and Molecular Teratology, 2006, 76(11), 762-769.
• Canfield, M.A, Honein, M.A, Yuskiv, N, et al., National estimates and race/ethnic-specific variation of selected birth defects in the United States, 1999-2001, Birth Defects Research Part A Clinical Molecular Teratology, 2006, 76(11): 747-756.
• Oster, M.E, Lee, K.A, Honein, M.A, et al., Temporal trends in survival among infants with critical congenital heart defects, Pediatrics, 2013, 131(5), 1502-1508.
• Granelli, A.W, Meberg, A, Ojala, T, Steensberg, J, Oskarsson, G, Mellander, M. Nordic pulse oximetry screening-implementation status and proposal for uniform guidelines, Acta Paediatrica, 2014, 103(11), 1136-1142.
• Riede, F.T, Wörner, C, Dahnert, I, Möckel, A, Kostelka, M, Schneider, P, Effectiveness of neonatal pulse oximetry screening for detection of critical congenital heart disease in daily clinical routine: results from a prospective multicenter study, European Journal of Pediatrics, 2010, 169(8), 975-981.
• Mai, C.T, Riehle-Colarusso, T, O’Halloran, A, Cragan, J.D, Olney, R.S, Lin, A, et al., National Birth Defects Prevention Network. Selected Birth Defects Data from Population-based Birth Defects Surveillance Programs in the United States, 2005-2009: Featuring Critical Congenital Heart Defects Targeted for Pulse Oximetry Screening, Birth Defects Research Part A Clinical Molecular Teratology, 2012, 94(12): 970-983.
• Kemper, A.R, Mahle, W.T, Martin, G.R, et al., Strategies for implementing screening for critical congenital heart disease. Pediatrics, 2011, 128(5), e1259-1267.
• Harold, J.G, Cardiology patient page, Screening for critical congenital heart disease in newborns, Circulation, 2014, 130(9): 79-81.
• Granelli, A.W, Wennergren, M, Sandberg, K, Mellander, M, Bejlum, C, Inganäs, L, 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, Britich Medical Journal, 2009, 338, e3037.
• Narayen, I.C, Blom, N.A, Ewer, A.K, Vento, M, Manzoni, P, te Pas, A.B, Aspects of pulse oximetry screening for critical congenital heart defects: when, how and why? Archives of Disease in Childhood, Fetal and Neonatal Edition, 2016, 101(2), 162-167.
• Manzoni, P, Martin, G.R, Luna, M.S, Mestrovic, J, Simeoni, U, Zimmermann, L, et al., European Pulse Oximetry Screening Workgroup. Pulse oximetry screening for critical congenital heart defects: a European consensus statement, Lancet Child and Adolescent Health, 2017, 1(2), 88-90.
• Ewer, A.K, Middleton, L.J, Furmston, A.T, Bhoyar, A, Daniels, J.P, Thangaratinam, S et al, for the PulseOx Study Group, Pulse oximetry screening for congenital heart defects in newborn infants (PulseOx): a test accuracy study, Lancet, 2011, 378, 785–94.
• Ewer, A.K, Martin, G.R., Newborn pulse oximetry screening: which algorithm is best? Pediatrics, 2016, 138, e20161206.
• Sendelbach, D.M, Jackson, G.L, Lai, S.S, Fixler, D.E, Stehel, E.K, Engle, W.D, Pulse oximetry screening at 4 hours of age to detect critical congenital heart defects, Pediatrics, 2008, 122(4), e815-20.
• Patriciu, M, Avasiloaiei, A, Moscalu, M , Stamatin, M, Pulse Oximetry During the First 24 Hours as a Screening Tool for Congenital Heart Defects, Journal of Critical Care Medicine, 2017, 3(1), 12-17.
• Uygur, O, Koroglu, O.A , Levent, E , Tosyali, M , Akisu, M, Yalaz, M, Kultursay, N, The value of peripheral perfusion index measurements for early detection of critical cardiac defects, Pediatrics and Neonatology, 2019, 60, 68-73.
• Özalkaya, E, Akdağ, A, Şen, I, Cömer, E, Melek Yaren, H, Early screening for critical congenital heart defects in asymptomatic newborns in Bursa province, Journal of Maternal-Fetal and Neonatal Medicine, 2016, 29, 1105-1107.
• Mawson, I.E, Babu, P.L, Simpson, J.M, Fox, G.F, Pulse oximetry findings in newborns with antenatally diagnosed congenital heart disease, European Journal of Pediatrics, 2018, 177(5), 683-689.
• Plana, N.M, Zamora, J, Suresh, G, Fernandez-Pineda, L, Thangaratinam, S, Ewer, A.K, Pulse oximetry screening for critical congenital heart defects, Cochrane Database of Systematic Reviews, 2018, 3(3), CD011912.