Unilateral incomplete retinal vascularization due to congenital heart disease in a full-term newborn

Abstract Context: Iodine is a micronutrient essential for thyroid hormone synthesis. Thyroid hormone is critical for normal neurocognitive development in young infants, and even transient hypothyroidism can cause adverse neurodevelopmental outcomes. Both iodine deficiency and excess can cause hypothyroidism. Although iodine-induced hypothyroidism is well recognized in premature infants, full-term neonates have received less attention. Infants with congenital heart disease (CHD) are commonly exposed to excess iodine from administration of iodinated contrast agents during cardiac catheterization as well as topical application of iodine-containing antiseptics and dressings; hence, this is a vulnerable population. Objective: We report three cases of iodine-induced hypothyroidism in full-term neonates with CHD after cardiac angiography and topical application of iodine-containing antiseptics and dressings in the operative setting. Results: Three neonates with CHD and normal thyroid function at birth developed hypothyroidism after exposure to excess iodine. Two of these infants had transient hypothyroidism, and one had severe hypothyroidism requiring ongoing thyroid replacement therapy. All infants were asymptomatic, with hypothyroidism detected incidentally in the inpatient setting due to repeat newborn screening mandated by the long duration of hospitalization in these infants. Conclusions: Iodine-induced hypothyroidism may be under-recognized in infants with CHD exposed to excess iodine. Systematic monitoring of thyroid function should be considered to avoid potential long-term adverse neurodevelopmental effects of even transient thyroid dysfunction in this susceptible population.

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Cost-Effectiveness Analysis of Pulse Oximetry Screening in the Full-Term Neonates for Diagnosis of Congenital Heart Disease: A Systematic Review

Iranian Journal of Pediatrics ◽

10.5812/ijp.105393 ◽

2020 ◽

Vol 30 (5) ◽

Author(s):

Shahin Nargesi ◽

Aziz Rezapour ◽

Aghdas Souresrafil ◽

Zeinab Dolatshahi ◽

Farnaz Khodaparast

Keyword(s):

Systematic Review ◽

Congenital Heart Disease ◽

Heart Disease ◽

Economic Evaluation ◽

Cost Effectiveness ◽

Early Detection ◽

Pulse Oximetry ◽

Congenital Heart ◽

Full Term ◽

Cochrane Library

Context: Congenital heart disease (CHD) is a leading cause of mortality by birth defects with significant social and economic burden. Pulse oximetry as a safe and non-invasive screening method, and with its potential for early detection of CHD has improved neonatal health outcomes. Objectives: The aim of this study was to systematically review economic evaluation studies that compared pulse oximetry with current programs to diagnose early detection of CHD in full-term newborns. Data Sources: A systematic review was conducted according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, and related articles published from 1995 up to March 2020 were searched in different databases (MEDLINE, EMBASE, PubMed, Science Direct, Google Scholar, Scopus, NHS EED, Science Citation Index, MagIran, Cochrane Library, EconLit and SID). The articles were selected based on inclusion and exclusion criteria. Consolidated health economic evaluation reporting standards (CHEERS) statement checklist was used to qualitatively evaluate the papers. Overall, 7 articles were included in the study. Results: Timely diagnosis was considered as main effectiveness health outcome in most studies. The highest and lowest values of incremental cost-effectiveness ratio (in two-phase studies) were €139,000 and $100 per infant in the Netherlands and Colombia respectively; and (in one-phase studies) were £24,000 and £1,489 per infant both belonging to the UK. Implementing pulse oximetry method concurrent with the clinical examination is more cost-effective. The reviewed studies had been conducted in high-income and upper middle-income countries; therefore, when the results are generalizing by policy makers in different health systems, a substantial precaution approach is needed.

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Pulse oximetry screening for critical congenital heart disease in term and late pre-term newborn

Sri Lanka Journal of Child Health ◽

10.4038/sljch.v48i4.8823 ◽

2019 ◽

Vol 48 (4) ◽

pp. 308

Author(s):

Pinar Arican ◽

Sultan Kavuncuoglu

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Pulse Oximetry ◽

Congenital Heart ◽

Critical Congenital Heart Disease ◽

Term Newborn ◽

Pulse Oximetry Screening

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FREQUENCY AND SIGNIFICANCE OF CARDIAC MURMURS IN THE FIRST YEAR OF LIFE

PEDIATRICS ◽

10.1542/peds.15.2.169 ◽

1955 ◽

Vol 15 (2) ◽

pp. 169-179

Author(s):

Mary R. Richards ◽

Katharine K. Merritt ◽

Mary H. Samuels ◽

Alfred G. Langmann

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Full Term ◽

First Year ◽

Cardiac Murmur ◽

Term Infants ◽

Relative Rarity ◽

First Year Of Life ◽

First Time

The frequency of cardiac murmurs in early infancy has been studied in a large series of unselected infants. In the immediate postnatal examination, a murmur was heard in 1.7 per cent. With repeated examinations, however, at 6 and at 12 months of age, the proportion of infants in whom a cardiac murmur was heard at some time rose to 7.0 per cent of 5,017 full-term singlebirth infants and to 9.9 per cent of 364 premature single-birth infants. Non-white infants had a significantly higher prevalence of murmurs than did white infants at both the 6 and 12 month examinations. Of the 71 full-term infants who had murmurs at the birth examination and were re-examined at both 6 and 12 months, 49 (69 per cent) had no murmurs at either of the later examinations. Of the 150 full-term infants who had murmurs heard for the first time at 6 months and were re-examined at 12 months, 90 (60 per cent) had no murmur at the 12-month examination. Of the total number of 353 murmurs heard in full-term infants, 166 were ultimately interpreted to be functional, and 25 to be organic murmurs. The remaining 162 were inconstantly present, and were probably all functional murmurs. In our experience, a murmur heard at birth carries a 1:12 probability of congenital heart disease; if it is again heard at 6 months, this chance is 1:3; and if the murmur persists to 12 months, the chance is 3:5 that congenital heart disease is present. When a murmur is first heard at 6 months, and persists until 12 months, the probability of congenital heart disease is 1:7; and when a murmur is first heard at 12 months, the probability falls to 1:50. Premature infants were found to be similar to full-term infants in all respects, insofar as their small numbers made comparisons possible. Finally, the relative rarity of cardiac murmurs in the newborn period has been demonstrated once more.

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