Is pulse oximetry helpful for the early detection of critical congenital heart disease at high altitude?

González-Andrade, Fabricio; Echeverría, Daniel; López, Valeria; Arellano, Michaela

doi:10.1111/chd.12654

Cited by 11 publications

(8 citation statements)

References 19 publications

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“…3 In Denver, despite being at a similar altitude to Albuquerque, New Mexico, the mean post-ductal saturations measured at term spanned from 92 to 93% with a range between 80 and 98% at 5280 ft/1610 m. 12 In Quito, Ecuador, at an altitude of 9252 ft, the mean pre-and post-ductal saturations were substantially lower at 92.77 (standard deviation ± 3) and 93.76% (standard deviation ± 2.83), respectively. 13 Likewise, the frequency of a positive screen increased with increasing altitude from 0.2% for infants born at sites at or less than 2000 ft to 6% for infants born at sites above 6000 ft. Enrollment at 8163 ft was stopped after enrolling 65 infants because of a very high false-positive rate (35%). 14 Altitude affects newborn saturations by causing delayed transition from fetal to neonatal circulation because of lower partial pressure of oxygen, restricting the degree of expected pulmonary vasodilation.…”

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confidence: 91%

Pulse oximetry screening for detection of congenital heart defects at 1646 m in Albuquerque, New Mexico

et al. 2020

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Aim: To determine the false-positive rate of pulse oximetry screening at moderate altitude, presumed to be elevated compared with sea level values and assess change in false-positive rate with time. Methods: We retrospectively analysed 3548 infants in the newborn nursery in Albuquerque, New Mexico, (elevation 5400 ft) from July 2012 to October 2013. Universal pulse oximetry screening guidelines were employed after 24 hours of life but before discharge. Newborn babies between 36 and 36 6/7 weeks of gestation, weighing >2 kg and babies >37 weeks weighing >1.7 kg were included in the study. Log-binomial regression was used to assess change in the probability of false positives over time. Results: Of the 3548 patients analysed, there was one true positive with a posteriorly-malaligned ventricular septal defect and an interrupted aortic arch. Of the 93 false positives, the mean pre- and post-ductal saturations were lower, 92 and 90%, respectively. The false-positive rate before April 2013 was 3.5% and after April 2013, decreased to 1.5%. There was a significant decrease in false-positive rate (p = 0.003, slope coefficient = −0.082, standard error of coefficient = 0.023) with the relative risk of a false positive decreasing at 0.92 (95% CI 0.88–0.97) per month. Conclusion: This is the first study in Albuquerque, New Mexico, reporting a high false-positive rate of 1.5% at moderate altitude at the end of the study in comparison to the false-positive rate of 0.035% at sea level. Implementation of the nationally recommended universal pulse oximetry screening was associated with a high false-positive rate in the initial period, thought to be from the combination of both learning curve and altitude. After the initial decline, it remained steadily elevated above sea level, indicating the dominant effect of moderate altitude.

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confidence: 91%

Pulse oximetry screening for detection of congenital heart defects at 1646 m in Albuquerque, New Mexico

et al. 2020

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“…In this framework, pulse oximetry is an appropriate method for determining the limit of cardiopulmonary stress in exercise testing characterized by a significant drop in oxygen saturation value [63,68,104,105]. Therefore, its application may be extended to the medical clinic to continuously monitor arterial blood oxygenation during exertion in people with known diseases [106][107][108][109][110] and at high altitudes [39,[111][112][113][114][115].…”

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confidence: 99%

Oxygen Saturation Behavior by Pulse Oximetry in Female Athletes: Breaking Myths

et al. 2021

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The myths surrounding women’s participation in sport have been reflected in respiratory physiology. This study aims to demonstrate that continuous monitoring of blood oxygen saturation during a maximal exercise test in female athletes is highly correlated with the determination of the second ventilatory threshold (VT2) or anaerobic threshold (AnT). The measurements were performed using a pulse oximeter during a maximum effort test on a treadmill on a population of 27 healthy female athletes. A common behavior of the oxygen saturation evolution during the incremental exercise test characterized by a decrease in saturation before the aerobic threshold (AeT) followed by a second significant drop was observed. Decreases in peripheral oxygen saturation during physical exertion have been related to the athlete’s physical fitness condition. However, this drop should not be a limiting factor in women’s physical performance. We found statistically significant correlations between the maximum oxygen uptake and the appearance of the ventilatory thresholds (VT1 and VT2), the desaturation time, the total test time, and between the desaturation time and the VT2. We observed a relationship between the desaturation time and the VT2 appearance. Indeed, a linear regression model between the desaturation time and the VT2 appearance can predict 80% of the values in our sample. Besides, we suggest that pulse oximetry is a simple, fairly accurate, and non-invasive technique for studying the physical condition of athletes who perform physical exertion.

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“…10,11 It is also important to consider that at high altitude modification of cutoff criteria is necessary when using pulse oximetry as a screening method for congenital heart disease in newborns. 12…”

Section: S Pecifi C Issue S In Ped Iatri C Patientsmentioning

confidence: 99%

Respiratory physiology at high altitude and considerations for pediatric patients

Bebic

Peterson

Polaner

2022

Pediatric Anesthesia

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There are over 150 million people that live at altitudes over 2500 m.More than half live in Asia and roughly one quarter in the Andes.A much greater number live at moderate altitudes of over 1500 m, and many people who live at low elevations come to high-altitude locations for recreation. A sizable percentage of these populations are children. Many physiological differences occur at moderate or high altitude that affect the health of this population, can affect the delivery of anesthetics in these locations, and can alter the reaction of our patients to anesthesia. This monograph will discuss the basics of altitude physiology and pathophysiology, how these affect the delivery of anesthetics, and some of the issues specific to pediatric patients in the high-altitude environment.As early as the mid-19th century, it has been appreciated that the administration of anesthesia at high altitudes poses a unique set of challenges, requiring the anesthesiologist to have an awareness and appreciation for both the physiologic adaptations and pharmacologic nuances that occur in a hypoxic environment. Firth provides a fascinating account of early anesthetics administered at high altitude. 1

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Is pulse oximetry helpful for the early detection of critical congenital heart disease at high altitude?

Cited by 11 publications

References 19 publications

Pulse oximetry screening for detection of congenital heart defects at 1646 m in Albuquerque, New Mexico

Pulse oximetry screening for detection of congenital heart defects at 1646 m in Albuquerque, New Mexico

Oxygen Saturation Behavior by Pulse Oximetry in Female Athletes: Breaking Myths

Respiratory physiology at high altitude and considerations for pediatric patients

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