Diagnostic Value of Clinical Symptoms and Pulse Oximetry for diagnosis of Congenital Heart Disease in Infants

The diagnosis of the Pierre Robin Syndrome, cleft palate, micrognathia, and golssoptosis is re-emphasized. The clinical symptoms are discussed. The treatments advocated in the literature are described. A simple traction device, employing a horizontal suture through the mid-body of the tongue and an elastic traction system, is explained. Five cases of the syndrome are reported. In one the condition was mild; in the other four the tongue traction device was employed. In one sick infant with a congenital heart disease a tracheotomy had to be performed. Much difficulty was experienced following this, and the operation is only recommended when traction alone does not control the handling of the profusion of mucus and bouts of apnea. A removable acrylic palatine obturator was used as an adjunct to nipple feedings in three patients, with excellent results. The method of production of this "false palate" is described.

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Should we start a nationwide screening program for critical congenital heart disease in Turkey? A pilot study on four centres with different altitudes

Cardiology in the Young ◽

10.1017/s1047951119000052 ◽

2019 ◽

Vol 29 (4) ◽

pp. 475-480

Author(s):

Dilek Dilli ◽

Vehbi Doğan ◽

Banu M. Özyurt ◽

Abdullah Özyurt ◽

Nilay Hakan ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Pulse Oximetry ◽

Congenital Heart ◽

Screening Program ◽

Critical Congenital Heart Disease ◽

Multi Centre Study ◽

Geographical Regions ◽

The Mean ◽

Different Altitudes

AbstractBackground: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.

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

Military Medicine ◽

10.1093/milmed/usz116 ◽

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.

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