scholarly journals Newborn Screening Pulse Oximetry to Detect Critical Congenital Heart Disease: A Follow-Up Survey of Current Practice at Army, Navy and Air Force Hospitals

2019 ◽  
Vol 184 (11-12) ◽  
pp. 826-831
Author(s):  
David L Robinson ◽  
Mark S Craig ◽  
Ronald S Wells ◽  
Kirk N Liesemer ◽  
Matthew A Studer
Keyword(s):  
Congenital Heart Disease ◽  
Quality Assurance ◽  
Heart Disease ◽  
Pulse Oximetry ◽  
Air Force ◽  
Congenital Heart ◽  
The United States ◽  
P Value ◽  
Critical Congenital Heart Disease

Abstract Introduction The purpose of this study was to assess the evolution of newborn pulse oximetry screening (+POx) among Army, Air Force, and Naval military hospitals (MH), including prevalence, protocol use, quality assurance processes, access to echocardiography, and use of telemedicine. This is a follow-up from a prior study published in 2011. Materials and Methods An Internet-based questionnaire was forwarded to the chief pediatrician at MH worldwide which support newborn deliveries. Descriptive data were reported using percentages. Grouped responses, as applicable, were further compared using the chi-square test. A p-value < 0.05 was considered statistically significant. Results Seventy-eight percent (36/46) of MH supporting deliveries worldwide responded to the survey (17 Army hospitals, 11 Navy Hospitals, 8 Air Force hospitals). All responding hospitals utilize +POx, of which 94% endorsed protocol compliance with the American Academy of Pediatrics guidelines. Nine (25%) hospitals were located outside of the United States. Delivery volumes (infants per month) range between 1–49 (36%), 50–99 (28%), 100–199 (19%), and 200–300 (17%). Eleven hospitals reported regular review of +POx data, with most reviewing them monthly. Four MH share findings with state institutions. Ten hospitals either have a staff pediatric cardiologist or use tele-echocardiography for on-site evaluations. Ten hospitals are located greater than 60 miles from the nearest center with echocardiography capabilities. Of the five hospitals using tele-echocardiography, four confirmed critical congenital heart disease (CCHD) using this practice, and all five reported averting transfer of an infant using this technology. Of the 22 hospitals lacking the ability to obtain on-site echocardiography, 12 (55%) are interested in implementing a tele-echocardiography protocol. Conclusions All responding MH use +POx, representing significant increase from the 30% of MH reporting use of +POx seven years ago. The majority of MH follow AAP +POx guidelines, and though most have providers review results prior to discharge, only one-third report periodic chart review for quality assurance. Most MH transfer infants with positive +POx results for evaluation due to a lack of on-site echocardiography. Tele-echocardiography was reported as a potential solution to diagnose or rule out CCHD. Over half of remaining hospitals without cardiologists are interested in using this technology to evaluate stable infants with positive CCHD screening.

Newborn Critical Congenital Heart Disease Screening Using Pulse Oximetry: Nursing Aspects

2016 ◽  
Vol 33 (11) ◽  
pp. 1072-1075 ◽  
Author(s):  
Lisa Hom ◽  
Gerard Martin
Keyword(s):  
United States ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulse Oximetry ◽  
Congenital Heart ◽  
The United States ◽  
Critical Congenital Heart Disease ◽  
Nursing Leaders ◽  
Nurse Role

Congenital heart disease (CCHD) is the most common birth defect. Screening for the most critical forms (CCHD) using pulse oximetry was added to the Recommended Uniform Screening Panel in the United States in 2011. Since then, CCHD screening has become nearly universal in the United States. Nurses are ideally situated to contribute to the development of best practices for implementation and provide education to families on CCHD screening. Much of the standardization, advocacy, and development of national recommendations occurred with key input from nurses. Nurses often have responsibility for educating parents, performing the screening, interpreting the screening algorithm, and the documentation of results. The nurse role often includes implementing follow-up quality improvement initiatives to ensure that systematic and accurate screening occurs. Smooth implementation can be achieved by identifying champions early, obtaining input from a multidisciplinary team including both physician and nursing leaders, and identifying ways to integrate screening into already existing workflow. By knowing the basics of why screening is important, how to screen, current recommendations on the follow-up for positive screens and the limitations of CCHD screening, nurses can advocate for their patients and positively impact outcomes for infants born with CCHD through early identification before discharge.

scholarly journals Universal Pulse Oximetry Screening for Early Detection of Critical Congenital Heart Disease

2016 ◽  
Vol 10 ◽  
pp. CMPed.S33086 ◽  
Author(s):  
Praveen Kumar
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Early Detection ◽  
Early Diagnosis ◽  
Pulse Oximetry ◽  
Congenital Heart ◽  
Developed Countries ◽  
The United States ◽  
Critical Congenital Heart Disease ◽  
Pulse Oximetry Screening

Critical congenital heart disease (CCHD) is a major cause of infant death and morbidity worldwide. An early diagnosis and timely intervention can significantly reduce the likelihood of an adverse outcome. However, studies from the United States and other developed countries have shown that as many as 30%–50% of infants with CCHD are discharged after birth without being identified. This diagnostic gap is likely to be even higher in low-resource countries. Several large randomized trials have shown that the use of universal pulse-oximetry screening (POS) at the time of discharge from birth hospital can help in early diagnosis of these infants. The objective of this review is to share data to show that the use of POS for early detection of CCHD meets the criteria necessary for inclusion to the universal newborn screening panel and could be adopted worldwide.

scholarly journals Using Pulse Oximetry Waveforms to Detect Coarctation of the Aorta

2020 ◽  
Author(s):  
Matthew Sorensen ◽  
Ismail Sadiq ◽  
Gari D. Clifford ◽  
Kevin O. Maher ◽  
Matthew E. Oster
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulse Oximetry ◽  
Congenital Heart ◽  
Lower Extremities ◽  
Coarctation Of The Aorta ◽  
Waveform Analysis ◽  
P Value ◽  
Critical Congenital Heart Disease ◽  
Upper And Lower Extremities

Abstract Background Coarctation of the aorta is a common form of critical congenital heart disease that remains challenging to diagnose prior to clinical deterioration. Despite current screening methods infants with coarctation may present with life threatening cardiogenic shock requiring urgent hospitalization and intervention. We sought to improve critical congenital heart disease screening by using a novel pulse oximetry waveform analysis, specifically focused on detection of coarctation of the aorta. Methods and Results Over a 2-year period, we obtained pulse oximetry waveform data on 18 neonates with coarctation of the aorta and 18 age-matched controls hospitalized in the cardiac intensive care unit at Children’s Healthcare of Atlanta. Patients with coarctation were receiving Prostaglandin E1 and had a patent ductus arteriosus. By analyzing discrete features in the waveforms, we identified statistically significant differences in the maximum rate of fall between patients with and without coarctation. This was accentuated when comparing the difference between the upper and lower extremities, with the lower extremities having a shallow slope angle when a coarctation was present (p-value 0.001). Postoperatively, there were still differences in the maximum rate of fall between the repaired coarctation patients and controls; however, these differences normalized when compared with the same individual’s upper vs. lower extremities. Coarctation patients compared to themselves (preoperatively and postoperatively), demonstrated waveform differences between upper and lower extremities that were significantly reduced after successful surgery (p-value 0.028). This screening algorithm had an accuracy of detection of 72% with 0.61 sensitivity and 0.94 specificity. Conclusions We were able to identify specific features in pulse oximetry waveforms that were unique to patients with coarctation and further demonstrated that these changes normalized after surgical repair. Pulse oximetry screening for congenital heart disease in neonates may thus be improved by including waveform analysis, aiming to identify coarctation of the aorta prior to critical illness. Further large-scale testing is required to validate this screening model among patients in a newborn nursery setting who are low risk for having coarctation.

scholarly journals Using Pulse Oximetry Waveforms to Detect Coarctation of the Aorta

2020 ◽  
Author(s):  
Matthew Sorensen ◽  
Ismail Sadiq ◽  
Gari D. Clifford ◽  
Kevin O. Maher ◽  
Matthew E. Oster
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulse Oximetry ◽  
Congenital Heart ◽  
Lower Extremities ◽  
Coarctation Of The Aorta ◽  
Waveform Analysis ◽  
P Value ◽  
Critical Congenital Heart Disease ◽  
Upper And Lower Extremities

Abstract Background Coarctation of the aorta is a common form of critical congenital heart disease that remains challenging to diagnose prior to clinical deterioration. Despite current screening methods infants with coarctation may present with life threatening cardiogenic shock requiring urgent hospitalization and intervention. We sought to improve critical congenital heart disease screening by using a novel pulse oximetry waveform analysis, specifically focused on detection of coarctation of the aorta. Methods and Results Over a 2-year period, we obtained pulse oximetry waveform data on 18 neonates with coarctation of the aorta and 18 age-matched controls hospitalized in the cardiac intensive care unit at Children’s Healthcare of Atlanta. Patients with coarctation were receiving Prostaglandin E1 and had a patent ductus arteriosus. By analyzing discrete features in the waveforms, we identified statistically significant differences in the maximum rate of fall between patients with and without coarctation. This was accentuated when comparing the difference between the upper and lower extremities, with the lower extremities having a shallow slope angle when a coarctation was present (p-value 0.001). Postoperatively, there were still differences in the maximum rate of fall between the repaired coarctation patients and controls; however, these differences normalized when compared with the same individual’s upper vs. lower extremities. Coarctation patients compared to themselves (preoperatively and postoperatively), demonstrated waveform differences between upper and lower extremities that were significantly reduced after successful surgery (p-value 0.028). This screening algorithm had an accuracy of detection of 72% with 0.61 sensitivity and 0.94 specificity. Conclusions We were able to identify specific features in pulse oximetry waveforms that were unique to patients with coarctation and further demonstrated that these changes normalized after surgical repair. Pulse oximetry screening for congenital heart disease in neonates may thus be improved by including waveform analysis, aiming to identify coarctation of the aorta prior to critical illness. Further large-scale testing is required to validate this screening model among patients in a newborn nursery setting who are low risk for having coarctation.

scholarly journals Using Pulse Oximetry Waveforms to Detect Coarctation of the Aorta

2020 ◽  
Author(s):  
Matthew Sorensen ◽  
Ismail Sadiq ◽  
Gari D. Clifford ◽  
Kevin O. Maher ◽  
Matthew E. Oster
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulse Oximetry ◽  
Congenital Heart ◽  
Lower Extremities ◽  
Coarctation Of The Aorta ◽  
Waveform Analysis ◽  
P Value ◽  
Critical Congenital Heart Disease ◽  
Upper And Lower Extremities

Abstract Background Coarctation of the aorta is a common form of critical congenital heart disease that remains challenging to diagnose prior to clinical deterioration. Despite current screening methods infants with coarctation may present with life threatening cardiogenic shock requiring urgent hospitalization and intervention. We sought to improve critical congenital heart disease screening by using a novel pulse oximetry waveform analysis, specifically focused on detection of coarctation of the aorta. Methods and Results Over a 2-year period, we obtained pulse oximetry waveform data on 18 neonates with coarctation of the aorta and 18 age-matched controls hospitalized in the cardiac intensive care unit at Children’s Healthcare of Atlanta. Patients with coarctation were receiving Prostaglandin E1 and had a patent ductus arteriosus. By analyzing discrete features in the waveforms, we identified statistically significant differences in the maximum rate of fall between patients with and without coarctation. This was accentuated when comparing the difference between the upper and lower extremities, with the lower extremities having a shallow slope angle when a coarctation was present (p-value 0.001). Postoperatively, there were still differences in the maximum rate of fall between the repaired coarctation patients and controls; however, these differences normalized when compared with the same individual’s upper vs. lower extremities. Coarctation patients compared to themselves (preoperatively and postoperatively), demonstrated waveform differences between upper and lower extremities that were significantly reduced after successful surgery (p-value 0.028). This screening algorithm had an accuracy of detection of 72% with 0.61 sensitivity and 0.94 specificity. Conclusions We were able to identify specific features in pulse oximetry waveforms that were unique to patients with coarctation and further demonstrated that these changes normalized after surgical repair. Pulse oximetry screening for congenital heart disease in neonates may thus be improved by including waveform analysis, aiming to identify coarctation of the aorta prior to critical illness. Further large-scale testing is required to validate this screening model among patients in a newborn nursery setting who are low risk for having coarctation.

scholarly journals Using Pulse Oximetry Waveforms to Detect Coarctation of the Aorta

2020 ◽  
Author(s):  
Matthew Sorensen ◽  
Ismail Sadiq ◽  
Gari D. Clifford ◽  
Kevin O. Maher ◽  
Matthew E. Oster
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulse Oximetry ◽  
Congenital Heart ◽  
Lower Extremities ◽  
Coarctation Of The Aorta ◽  
Waveform Analysis ◽  
P Value ◽  
Critical Congenital Heart Disease ◽  
Upper And Lower Extremities

Abstract Background Coarctation of the aorta is a common form of critical congenital heart disease that remains challenging to diagnose prior to clinical deterioration. Despite current screening methods infants with coarctation may present with life threatening cardiogenic shock requiring urgent hospitalization and intervention. We sought to improve critical congenital heart disease screening by using a novel pulse oximetry waveform analysis, specifically focused on detection of coarctation of the aorta.Methods and Results Over a 2-year period, we obtained pulse oximetry waveform data on 18 neonates with coarctation of the aorta and 18 age-matched controls hospitalized in the cardiac intensive care unit at Children’s Healthcare of Atlanta. Patients with coarctation were receiving Prostaglandin E1 and had a patent ductus arteriosus. By analyzing discrete features in the waveforms, we identified statistically significant differences in the maximum rate of fall between patients with and without coarctation. This was accentuated when comparing the difference between the upper and lower extremities, with the lower extremities having a shallow slope angle when a coarctation was present (p-value 0.001). Postoperatively, there were still differences in the maximum rate of fall between the repaired coarctation patients and controls; however, these differences normalized when compared with the same individual’s upper vs. lower extremities. Coarctation patients compared to themselves (preoperatively and postoperatively), demonstrated waveform differences between upper and lower extremities that were significantly reduced after successful surgery (p-value 0.028). This screening algorithm had an accuracy of detection of 72% with 0.61 sensitivity and 0.94 specificity.Conclusions We were able to identify specific features in pulse oximetry waveforms that were unique to patients with coarctation and further demonstrated that these changes normalized after surgical repair. Pulse oximetry screening for congenital heart disease in neonates may thus be improved by including waveform analysis, aiming to identify coarctation of the aorta prior to critical illness. Further large-scale testing is required to validate this screening model among patients in a newborn nursery setting who are low risk for having coarctation.

Abstract 15653: Optimizing the Screening Algorithm for Critical Congenital Heart Disease: A Data-Driven Approach

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Matthew Oster ◽  
Caglar Caglayan ◽  
Regina Simeone ◽  
Pinar Keskinocak ◽  
Turgay Ayer
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulse Oximetry ◽  
Test Performance ◽  
Congenital Heart ◽  
Optimal Algorithm ◽  
The United States ◽  
Performance Characteristics ◽  
Critical Congenital Heart Disease ◽  
Screening Programs

Introduction: Screening for critical congenital heart disease (CCHD) using pulse oximetry is performed with various algorithms in the United States, with none of these based on robust data, including the one endorsed by the AHA and other organizations. Hypothesis: Existing algorithms will have differing results for CCHD screening, and the test characteristics of these algorithms can be improved through modifications. Methods: After collecting de-identified, patient-level pulse oximetry values from existing national and international screening programs, we compared the commonly used algorithms in the US: the American Academy of Pediatrics (AAP) algorithm (endorsed by the AHA), the New Jersey (NJ) algorithm (slight modification of the AAP algorithm), and the Tennessee (TN) algorithm (screening first on the foot only). We then considered alternate algorithms by modifying the pulse oximetry values that would be considered a pass, fail, or retest result in the existing algorithms. We compared the algorithms according to sensitivity (Se), false positive rate (FP), and area under the curve (AUC). Results: There were 75,748 screenings, with 57 true positives. Performance characteristics of the 3 common algorithms are summarized in the Table. The NJ algorithm had the greatest Se but also the highest FP, and the TN algorithm had the lowest Se but also the lowest FP. Modifications of these algorithms yielded 2632 potential algorithms with Se ranging from 28% to 91%, FP from 0.05% to 60%, and AUC from 0.64 to 0.82. Of these, 224 algorithms met our optimal algorithm criteria of Se >50%, FP 0.75. Conclusions: Current algorithms for CCHD screening vary in their test performance characteristics, and there are opportunities to modify these algorithms to improve test performance. Before identifying an optimal algorithm, further work is needed to collect more data (including more robust data on false negatives) and to compare the cost and ease of use of potential algorithms.

scholarly journals Pulse Oximetry Screening Has Not Changed Timing of Diagnosis or Mortality of Critical Congenital Heart Disease

2020 ◽  
Vol 41 (5) ◽  
pp. 899-904 ◽  
Author(s):  
Matthew J. Campbell ◽  
William O. Quarshie ◽  
Jennifer Faerber ◽  
David J. Goldberg ◽  
Christopher E. Mascio ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulse Oximetry ◽  
Congenital Heart ◽  
Critical Congenital Heart Disease ◽  
Pulse Oximetry Screening
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