Evaluation of Neonates With Suspected Congenital Heart Disease: A New Cost-Effective Algorithm

Abstract

We assessed the value of existing guidelines for the evaluation of suspected congenital heart disease (CHD) in term neonates and propose a revised algorithm. Retrospective chart review of newborns referred for cardiac evaluation at a tertiary care center was performed. A total of 777 newborns qualified for the study. Among these, 3 critical and 8 major CHD were identified. The sensitivity of the combination of abnormal physical examination and pulse oximetry screening for major and critical CHD was 100%. The cost to detect a case of critical CHD, based on echocardiograms done for all abnormal electrocardiograms, was 3.4 times more than that incurred for performing this test on the basis of abnormal pulse oximetry and physical examination. Adding electrocardiogram to CHD screening increases cost without adding diagnostic yield. Based on our findings, we propose a revised algorithm for a systematic cost-effective approach to cardiac evaluation of term newborns with suspected CHD.

Congenital heart disease diagnosed with echocardiogram in newborns with asymptomatic cardiac murmurs: a systematic review

“…After reviewing the full texts of the remaining 20 studies, eight studies were further excluded for the following reasons: participants included symptomatic newborns (n = 4) or preterm infants (n = 4) (Additional file 2). Thus, a total of 12 studies were included in the analysis [24][25][26][28][29][30][31][32][33][34][35][36].…”

“…Characteristics of the studies and the subjects are summarized in Table 1. Of the included studies, six were cohort studies [25,26,28,29,32,33], four were crosssectional studies [24,30,31,34], and two were case reports [35,36]. A total of 1928 subjects were included in the 12 studies.…”

“…In most of the studies, the first cardiac evaluations were performed within five days of birth by pediatricians. Since 2012, screening newborns using a pulse oximeter has become standard practice [26,32,34,35]. Except in one study [32], additional assessments using Echo were performed by a pediatric cardiologist during the neonatal period before discharge (an additional assessment using Echo performed in an outpatient setting was excluded [30]).…”

“…Except in one study [32], additional assessments using Echo were performed by a pediatric cardiologist during the neonatal period before discharge (an additional assessment using Echo performed in an outpatient setting was excluded [30]). Additionally, some studies used chest x-ray [24], electrocardiogram [24,26,30,35], and four-limb blood pressure [26,35] to further evaluate cardiac murmurs.…”

“…Recently, it has become easy to implement Echo in neonatal care. Previous studies reported variable CHD incidence in newborns with ANCM [24][25][26]; however, there is no consensus on the use of Echo for early detection of CHD in newborns with ANCM. In this systematic review, we aimed to identify the incidence of CHD diagnosed with Echo and determine whether Echo should be used in the proper management of CHD in newborns with ANCM.…”