Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-08T15:26:19.120Z Has data issue: false hasContentIssue false
  • English
  • Français

Early clinical screening of neonates for congenital heart defects: the cases we miss

Published online by Cambridge University Press:  19 August 2008

Alf Meberg ,
Jan Erik Otterstad ,
Gisle Frøland ,
Jardar Hals  and
Svein Jan Sörland
Alf Meberg*
Affiliation:
Departments of Paediatrics, Vestfold County Central Hospital, N-3116 Tönsberg, Norway
Jan Erik Otterstad
Affiliation:
Departments of Internal Medicine, Vestfold County Central Hospital, N-3116 Tönsberg, Norway
Gisle Frøland
Affiliation:
Departments of Internal Medicine, Vestfold County Central Hospital, N-3116 Tönsberg, Norway
Jardar Hals
Affiliation:
Department of Paediatrics, Buskerud County Central Hospital, Drammen, Norway
Svein Jan Sörland
Affiliation:
Department of Paediatric Cardiology, Rikshospitalet The National Hospital, Oslo, Norway
*
Alf Meberg, MD. Departments ofl Paediatrics, Buskerud County Central Hospital, Drammen, Norway. Tel: 47-33-34-20-00; Fax: 47-33-34-39-63.
Get access Rights & Permissions [Opens in a new window]

Abstract

In a population-based study of 35,218 infants born alive during the 15 years from 1982 to 1996, 353(1%) were diagnosed as having a congenital heart defect, of whom 84 (24%) were diagnosed subsequent to discharge from hospital after birth (2.4/1000). Of these, 40 (48%) had a ventricular septal defect, 14 (17%) an atrial septal defect, 9 (11%) a patent arterial duct, 8 (10%) an aortic stenosis and 13 (15%) other defects. Compared with those in whom diagnosis was made before discharge, the group of patients with defects detected late had an increased prevalence of atrial septal defects, patent arterial duct and aortic stenosis, but less decreased prevalence of ventricular septal defects (p < 0.05). Median age at detection of the defects subsequent to discharge was 6 months (range 2 weeks–11 years). Seven patients (8%) presented with clinical symptoms of cardiac decompensation. The mortality rate was significantly lower in those in whom defects were detected late (1/84; 1%) as compared with those detected immediately after birth (37/269; 14%) (p < 0.05). The total rate for early detection was the same after using one clinical examination (8.2/1000) of newborns as our basic routine instead of two (7.1/1000) (p > 0.05). A substantial proportion of congenital cardiac malformations are detected after discharge from hospital after birth. Some patients with these lesions present with cardiac decompensation and are in need of medication and surgery. One clinical examination of newborns detects congenital malformations of the heart as efficient as two.

Keywords

Congenital heart defectslate detectionneonatal screening
Type
Original Articles
Information
Cardiology in the Young , Volume 9 , Issue 2 , March 1999 , pp. 169 - 174
Copyright
Copyright © Cambridge University Press 1999

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

1.Hoffman, JIE, Christianson, R. Congenital heart disease in a cohort of 19,502 births with long-term follow-up. Am J Cardiol 1978; 42: 641–647.CrossRefGoogle Scholar
2.Ferencz, C, Rubin, JD, McCarter, RJ, Brenner, JI, Neill, CA, Perry, LW, Hepner, SI, Dowing, JW. Congenital heart disease: prevalence at lvebirth. The Baltimore–Washington infant study. Am J Epidemiol 1985; 121: 31–36.Google Scholar
3.Eichhorn, P, Sütsch, G, Jenni, R. Echokardiographisch neu entdeckte kongenitale Vitien und Anomalien bei Adoleszenten und Erwachsenen. Schweiz Med Wochenschr 1990: 120: 1697–1700.Google Scholar
4.Hallidie-Smith, KA, Morais, P. Are major cardiac defects recognised in the newborn infants? Arch Dis Child 1986; 61: 629.Google Scholar
5.Abu, Harb M, Hey, E, Wren, C. Death in infancy from unrecognised congenital heart disease. Arch Dis Child 1994; 71: 3–7.Google Scholar
6.Meberg, A, Otterstad, JE, Frø, G, Sørland, S, Nitter-Hauge, S. Increasing incidence of ventricular septal defects caused by improved detection rate. Acta Paediatr 1994; 83: 653–657.Google Scholar
7.International Society of Cardiology: Classification of Heart Disease in Childhood. VBR Offsetdrukkerij, Groningen, 1970.Google Scholar
8.Fyler, DC, Buckley, LP, Hekkebrand, WE, Cohn, HE, Kirklin, JW, Nadas, AS, Cartier, JM, Breibart, MH. Report of the New England Regional Infant Cardiac Program. Pediatrics 1980 (suppl.); 65.Google Scholar
9.Bækgaard, Laursen H. Some epidemiological aspects of congenital heart disease in Denmark. Acta Paediatr Scand 1980; 69: 619–624.Google Scholar
10.Bernstein, D. The cardiovascular system. In: Behrman, RE, Kliegman, RM, Arvin, AM (eds), Nelson Textbook of Pediatrics, 15th edn. WB Saunders, Philadelphia, 1996, pp 1262–1374.Google Scholar
11.Mitchell, SC, Korones, SB, Berendes, HW. Congenital heart disease in 56,109 births. Incidence and natural history. Circulation 1971; 43: 323–332.Google Scholar
12.Carlgren, LE, Ericson, A, Källen, B. Monitoring of congenital cardiac defects. Pediatr Cardiol 1987; 8: 247–256.CrossRefGoogle ScholarPubMed
13.Hiraishi, S, Agata, Y, Nowatari, M, Oguchi, K, Misawa, H, Hirota, H, Fujino, N, Horiguchi, Y, Yashiro, K, Nakae, S. Incidence and natural course of trabecular ventricular septal defect: twodimensional echocardiography and color Doppler flow imaging study. J Pediatr 1992; 120; 409–415.Google Scholar
14.Sharland, G. Changing impact of fetal diagnosis of congenital heart disease. Arch Dis Child 1997; 77: F l–3.Google Scholar
15.Kelley, JR, Guntheroth, WG. Pansystolic murmur in the newborn: tricuspid regurgitation versus ventricular septal defect. Arch Dis Child 1988; 63: 1172–1174.Google Scholar
16.Mellgren, G, Südow, G. När upptäcks medfodda hjärtfel hos barn? Läkartidningen 1985; 82: 590–591.Google Scholar
17.Ing, FF, Starc, TJ, Griffiths, SP, Gersony, WM. Early diagnosis of coarctation of the aorta in children: a continuing dilemma. Pediatrics 1996; 98: 378–382.Google Scholar
18.Du, ZD, Roguin, N, Barak, M. Clinical and echocardiographic evaluation of neonates with heart murmurs. Acta Paediatr 1997; 86: 752–756.Google Scholar
19.Lee, SK, Perlman, M, Ballantyne, M, Elliott, I, To, T. Association between duration of neonatal hospital stay and readmission rate. J Pediatr 1995; 127: 758–766.Google Scholar
20.Carrlidge, PHT. Routine discharge examination of babies: is it necessary? Arch Dis Child 1992; 67: 1421–1422.Google Scholar
21.Moss, GD, Cartlidge, PHT, Speidel, BD, Chambers, TL. Routine examination in the neonatal period. Br Med J 1991; 302: 878–879.Google Scholar
22.Milerad, J, Larson, O, Hagberg, C, Ideberg, M. Associated malformations in infants with cleft lip and palate: a prospective, population-based study. Pediatrics 1997; 100: 180–186.CrossRefGoogle ScholarPubMed
23.Tubman, TRJ, Shields, MD, Craig, BG, Mulholland, HC, Nevin, NC. Congenital heart disease in Down's syndrome: two year prospective early screening study. Br Med J 1991; 302: 1425–1427.Google Scholar