Critical Congenital Heart Disease Screening Using Pulse Oximetry: Achieving a National Approach to Screening, Education and Implementation in the United States

Wandler, L.A.; Martin, Gerard R.

doi:10.3390/ijns3040028

Cited by 6 publications

(6 citation statements)

References 31 publications

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“…This study was in line with other study in Malaysia with rate of late detection was 51% [12]. The most relevant studies of late detection of CCHD in US published before the recommendation produced widely varied estimated 7.5% to 62.0% of infants with CCHD received late diagnosis [13,14]. This varied results varied significantly by the presence of extracardiac defects, CCHD types, study site, and income countries classification.…”

Section: Discussionsupporting

confidence: 89%

Early versus late diagnosis of critical congenital heart disease at Sanglah Hospital Denpasar, Bali

Dewi¹,

Gunawijaya²,

Yantie³

2022

GSC Adv. Res. Rev.

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Background: Critical congenital heart disease (CCHD) remains significant clinical and public health challenge. Risk of morbidity and mortality in CCHD increases when there is a delay in diagnosis and referral to a tertiary center with expertise in treating these patients. In the last few years, pulse oximetry screening for CCHD in newborns has been added to the list of recommended uniform screening panels and advocated by several health-care authorities. Early detection of CCHD by using pulse oxymetry was recommended by American Academy of Pediatrics (AAP), the American Heart Association, and the American College of Cardiology to improve early identification of infants with CCHD. Objective: To describe early versus late diagnosis of critical congenital heart disease (CCHD) at single tertiary center. Methods: A retrospective observational study was conducted in Sanglah Hospital, Bali. Data collected from medical records. Early diagnosis defined as diagnosis which made during prenatal examination or before birth hospital dischare. Late diagnosis defined as diagnosis which made after birth hospital discharge, after 3 days of birth, or even at death. Diagnosis of CCHD was retrieved based on echocardiography examination. Results: From June 2016 to February2020 we found 86 CCHD cases which were tetralogy of Fallot (41 cases), pulmonary atresia (15 cases), transposition of great arteries (14 cases), total anomalous pulmonary venous return (4 cases), tricuspid atresia (3 cases), truncus arteriosus (3 cases), and hypoplastic left heart syndrome (1 case). Only 26% cases of children with CCHD were diagnosed early, mostly came with chief complaint bluish appearance. Range of oxygen saturation at diagnosis varied from 51-90%. Among cases with late diagnosis, the most common defect was tetralogy of Fallot. Most late diagnosed CCHD came because of referral from other hospitals or pediatricians. Conclusion: The rate of delayed CCHD diagnosis still occurs in 74%. Factors that might be contribute to late CCHD diagnosis include certain CCHD types, nontertiary hospital nursery and absence of clinical findings.

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Section: Discussionsupporting

confidence: 89%

Early versus late diagnosis of critical congenital heart disease at Sanglah Hospital Denpasar, Bali

Dewi¹,

Gunawijaya²,

Yantie³

2022

GSC Adv. Res. Rev.

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“…It is known that failing a CCHD birth screening is not a definitive diagnosis of CCHD, but in fact, a newborn can fail the screening due to several other factors [ 30 , 31 ]. Due to this reason, a child with failed CCHD screening is referred for further investigations to detect the reason for failure [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of an electronic medical record-based automated screening program for critical congenital heart disease: Emirates Health Services, United Arab Emirates

Zarouni

Mheiri

Blooshi

et al. 2022

BMC Med Inform Decis Mak

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Background Almost eight children per 1000 live births are expected to have a congenital heart defect globally. The seven most critical congenital heart conditions that cause severe compromise on the patient’s quality and duration of life are collectively referred to as the Critical Congenital Heart Diseases (CCHD). CCHD is a critical condition that requires prompt detection and intervention as a life-saving measure. Pulse oximetry is a non-invasive, highly specific, and moderately sensitive method that can be used for screening new-borns for CCHD. The Emirates Health Services (EHS), UAE, adopted a strategy of developing a stringent program for newborn screening of Critical Congenital Heart disease, which would help in the early diagnosis and treatment of CCHD patients. An automated EMR (Wareed) driven solution was introduced to enhance this program as part of the routine workflow for the nurse care providers. Methods Our study is a retrospective observational study that aims to understand: the prevalence of CCHD in our target population and to study the impact of an automated program on screening compliance and its implications for early diagnosis of CCHD. Results We found that an EMR-driven automated screening program was highly effective in achieving high compliance (98.9%). It created a (statistically significant) improvement in the disease identification for CCHD in live births at EHS facilities. Conclusion We conclude that implementing an automated protocol through the EMR can effectively improve new-born screening coverage. It reduces the days to CCHD diagnosis, which would improve health outcomes in neonates.

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“…Pulse oximetry screening (POS) for CCHD has been shown to be a simple reliable method used to determine arterial oxygen saturation of hemoglobin in arterial blood and has been widely used in many areas of clinical medicine [7]. Particularly useful for identifying asymptomatic infants with CCHD in well-baby units, the importance of this screen is in its ability to allow for the early detection of CCHD prior to the infant being discharged from the hospital [7,8]. Late detection of CCHD, after hospital discharge, has been shown to increase morbidity and mortality.…”

Section: Cchd Screeningmentioning

confidence: 99%

Universal Screening for CCHD in Saudi Arabia: The Road to a ‘State of the Art’ Program

AlAql

Khaleel²,

Peter

2020

IJNS

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Critical congenital heart disease (CCHD) has been defined as structural heart defects that are usually associated with hypoxia in the newborn period and have potential for significant morbidity and mortality early in life. CCHD has been estimated to be present in ∼3 in 1000 live births, including Saudi Arabia. Pulse Oximetry Screening (POS) is a highly specific and moderately sensitive test for detecting CCHD with very low false-positive rates. The Kingdom of Saudi Arabia is among high-income countries with a population of more than 33 million and more than 600,000 annual live births. In 2015, the Universal Screening Program for CCHD using Pulse Oximetry was approved in Saudi Arabia. It is expected that any new national program will undergo a learning curve and face many challenges. We believe that developing countries may face different challenges during implementation of such national projects, but the success achieved by Saudi Arabia in implementing the program was mainly due to good preparation before launching the project and advancements in the use of the technology involved in this project. Since starting the universal CCHD screening in 2016, more than 900,000 babies have been screened in Saudi Arabia and many lives have been saved using this safe, non-invasive, inexpensive, and reasonably sensitive test.

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Critical Congenital Heart Disease Screening Using Pulse Oximetry: Achieving a National Approach to Screening, Education and Implementation in the United States

Cited by 6 publications

References 31 publications

Early versus late diagnosis of critical congenital heart disease at Sanglah Hospital Denpasar, Bali

Early versus late diagnosis of critical congenital heart disease at Sanglah Hospital Denpasar, Bali

Impact of an electronic medical record-based automated screening program for critical congenital heart disease: Emirates Health Services, United Arab Emirates

Universal Screening for CCHD in Saudi Arabia: The Road to a ‘State of the Art’ Program

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