Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-25T17:30:15.529Z Has data issue: false hasContentIssue false
  • English
  • Français

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 ,
Vehbi Doğan ,
Banu M. Özyurt ,
Abdullah Özyurt ,
Nilay Hakan ,
Sibel Bozabalı ,
İbrahim Caner ,
Haşim Olgun ,
Murat Koç  and
İrfan Taşoğlu
...Show all authors
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: [email protected]
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Critical congenital heart diseasescreeningnewbornpulse oximetry
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 4 , April 2019 , pp. 475 - 480
Copyright
© Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Frank, LH, Bradshaw, E, Beekman, R, et al. Critical congenital heart disease screening using pulse oximetry. J Pediatr 2013; 162: 445–453.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: F33–F35.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: 3–7.CrossRefGoogle Scholar
Hoffman, JI. It is time for routine neonatal screening by pulse oximetry. Neonatology 2011; 99: 1–9.CrossRefGoogle ScholarPubMed
Kemper, AR, Mahle, WT, Martin, GR, et al. Strategies for implementing screening for critical congenital heart disease. Pediatrics 2011; 128: 1259–1267.CrossRefGoogle ScholarPubMed
Ewer, AK. Screening for critical congenital heart defects with pulse oximetry: medical aspects. Am J Perinatol 2016; 33: 1062–1066.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: 761–765.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: 975–981.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: 2459–2464.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: 747–754. 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: 379–384.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: 1137–1140.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: e561–e569.CrossRefGoogle ScholarPubMed
Miao, CY, Zuberbuhler, JS, Zuberbuhler, JR. Prevalence of congenital cardiac anomalies at high altitude. J Am Coll Cardiol 1988; 12: 224–228.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: 148–151.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: 769–772.CrossRefGoogle Scholar
Ainsworth, SB, Wyllie, JP, Wren, C. Prevalence and clinical significance of cardiac murmurs in neonates. Arch Dis Child 1999; 80: F43–F45.CrossRefGoogle ScholarPubMed
Mellander, M, Sunnegardh, J. Failure to diagnose critical heart malformations in newborns before discharge – an increasing problem? Acta Paediatr 2006; 95: 407–413.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: 1455–1459.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: 370–376.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: 25–30.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: 451–455.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: 94–98.CrossRefGoogle ScholarPubMed
Richmond, S, Reay, G, AbuHarb, M. Routine pulse oximetry in the asymptomatic newborn. Arch Dis Child Fetal Neonatal Ed 2002; 87: F83–F88.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: 1105–1107.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