A Modified Algorithm for Critical Congenital Heart Disease Screening Using Pulse Oximetry

Diller, Christina L.; Kelleman, Michael; Kupke, Kenneth G.; Quary, Sharon; Kochilas, Lazaros; Oster, Matthew E.

doi:10.1542/peds.2017-4065

Cited by 41 publications

(35 citation statements)

References 20 publications

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“…We showed a very good sensitivity, but positive predictive value was less than optimal to detect CCHD. In a recent study, Diller et al 27 reported that modifying the screening algorithm to one repeat pulse oximetry test instead of two might detect additional infants with significant disease without a substantial increase in the false positive rate.…”

Section: Discussionmentioning

confidence: 99%

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

Díllí

Doğan

Ozyurt³

et al. 2019

Cardiol Young

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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.

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Section: Discussionmentioning

confidence: 99%

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

Díllí

Doğan

Ozyurt³

et al. 2019

Cardiol Young

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“…Pulse oximetry screening in the U.S. is recommended after 24 hours of life, 13 with a goal of identifying patients with hypoxemia with low false-positive results, before newborn discharge, which is typically 48 hours after birth. Infants with abnormal screening results must be referred to a physician, who evaluates the causes of hypoxemia.…”

Section: Data Sourcesmentioning

confidence: 99%

Effect of newborn screening for critical CHD on healthcare utilisation

et al. 2020

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Abstract Objective: To evaluate the impact of state-mandated policies for pulse oximetry screening on healthcare utilisation, with a focus on use of echocardiograms. Data sources/study setting: Healthcare Cost and Utilisation Project, Statewide Inpatient Databases from 2008 to 2014 from six states. Methods: We defined pre- and post-mandate cohorts based on dates when pulse oximetry became mandated in each state. Linear segmented regression models for interrupted time series assessed associations between implementation of the screening and changes in rate of newborns with Critical CHD-negative echocardiogram results. We also evaluated the changes in rate of newborns who underwent echocardiogram but were not diagnosed with any health issues that could cause hypoxemia. Results: We identified 5967 critical CHD-negative echocardiograms (2847 and 3120 in the pre- and post-mandate periods, respectively). Our models detected a statistically significant increasing trend in rate of critical CHD-negative echocardiograms in the pre-mandate period (Incidence Rate Ratio: 1.08, p = 0.02), but did not detect any statistical differences in changes between pre- and post-mandate periods (Incidence Rate Ratio: 0.93, p = 0.14). Among non-Whites, an increasing trend of Critical CHD-negative echocardiogram during the pre-mandate period was detected (Incidence Rate Ratio 1.12, p < 0.01) and was attenuated during the post-mandate period (Incidence Rate Ratio 0.89, p = 0.02). Similar results were observed in the sensitivity analyses among both Whites and non-Whites. Conclusions: Results suggest that mandatory state screening policies are associated with reductions in false-positive screening rates for hypoxemic conditions, with reductions primarily attributed to trends among non-Whites.

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“…Recently a modified screening algorithm with 1 repeat pulse oximetry test instead of 2 was found to detect additional infants with significant disease without a substantial increase in the false-positive rate [21].…”

Section: Original Research Articlementioning

confidence: 99%

Clinical accuracy of post graduate student in diagnosing congenital heart diseases (CHD) using an algorithmic approach and its comparison with echocardiography

Mehta¹,

Bhalse²

2018

Int J Pediatr Res

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Background: Congenital heart diseases (CHDs)are an important cause of morbidity and mortality in children. In view of poor availability of resources in developing nations like India, clinical evaluation of children with CHD is important. Aim: To study the clinical accuracy of post graduate student in diagnosing congenital heart diseases and its comparison with echocardiography. Subjects and Methods: A prospective cross-sectional study performed in the Department ofPediatrics of a tertiary level teaching hospital in central India. Participants were children with CHDs attending outpatient department or admitted in wards or PICU. History, general physical and cardiovascular examinations were recorded by the post graduate student. Chest X-ray and ECG were obtained. These findings were used to classify the defect using an algorithm and a clinical diagnosis was made which was matched with echocardiography.Kappa coefficient test was used to judge the degree of agreement between the two methods. Results: 80 patients with CHDs were included in the final analysis. 49 (61.25%) had acyanotic CHDs and ventricular septal defect (VSD) was the most common defect (n= 24, 30%) while tetralogy of Fallot (TOF) was the most common (n=14, 17.5%) cyanotic CHD. Concordance of clinical diagnosis and echocardiography was maximum for VSD (16/24, 66.6%) in acyanotic group and TOF (8/14, 57%) in cyanotic group. Kappa's coefficient test analysis also showed an "almost perfect" area of agreement for VSD (κ=0.87) and fair area of agreement for TOF (κ=0.65). For type of CHD (cyanotic or acyanotic) and type of ventricular hypertrophy (left, right or biventricular) it showed "almost perfect" and"fair" area of agreement respectively. Conclusion: Agreement between echocardiography and cclinical diagnosis of CHDs including hemodynamic parameters like type of ventricular hypertrophy and pulmonary arterial hypertension was reasonably accurate in our study.

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A Modified Algorithm for Critical Congenital Heart Disease Screening Using Pulse Oximetry

Cited by 41 publications

References 20 publications

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

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

Effect of newborn screening for critical CHD on healthcare utilisation

Clinical accuracy of post graduate student in diagnosing congenital heart diseases (CHD) using an algorithmic approach and its comparison with echocardiography

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