Newborn pulse oximetry screening in the context of a high antenatal detection rate of critical congenital heart disease

Abstract

Aim Assess the potential additional benefit from pulse oximetry screening in the early detection of critical congenital heart disease in a country with a well‐developed antenatal ultrasound screening programme. Methods Live‐born infants, pregnancy terminations and stillbirths from 20 weeks’ gestational age, between 2013 and 2015, with critical cardiac defects defined as primary or secondary targets of pulse oximetry screening were identified. Critical defects were those resulting in the death of a fetus or an infant in the first 28 days after birth, or a defect requiring intervention in the first 28 days. Results Two hundred and sixty‐eight infants and Fetuses were identified. Antenatal detection rates improved from 69% to 77% over the study period. An associated co‐morbidity improved antenatal detection rates. Twenty‐seven live‐born infants were diagnosed after discharge: 15 aortic arch obstruction (AAO); 10 d‐loop transposition of the great arteries (d‐TGA), and two total anomalous pulmonary venous drainage (TAPVD). Of these, five with AAO, nine with d‐TGA and likely both with TAPVD could potentially have been detected with oximetry screening. Conclusion The antenatal detection of critical cardiac anomalies continues to improve in New Zealand. Despite high antenatal detection rates for most lesions, universal postnatal oximetry screening has the potential to improve early detection.

Pulse oximetry screening in a midwifery‐led maternity setting with high antenatal detection of congenital heart disease

“…Maternity care provision for pregnant women is universally funded. The country has a well‐developed screening programme for the antenatal detection of congenital cardiac anomalies . Primary maternity care is provided by a Lead Maternity Carer (LMC).…”

“…The country has a well-developed screening programme for the antenatal detection of congenital cardiac anomalies. 6 Primary maternity care is provided by a Lead Maternity Carer (LMC). The majority of LMCs are midwives 7 who provide continuity of care in a partnership model from early pregnancy, through labour and birth, and up to 6 weeks post-partum.…”

Recommendations for the Adult Cardiac Sonographer Performing Echocardiography to Screen for Critical Congenital Heart Disease in the Newborn: From the American Society of Echocardiography

“…Despite advances in antenatal screening and fetal echocardiography, prenatal detection of CHD remains variable by geographic location and type of CHD lesion, with a recent report from the United States (US) estimating a detection rate of only 42% in 2012. [5][6][7] There was also significant geographic variation in rates of prenatal detection across states with a low of only 11%, further reinforcing the need to expand the ability of all sonographers to be able to adequately screen for C-CHD. Lesions identifiable on a 4-chamber view such as atrioventricular canal defect or hypoplastic left heart syndrome have detection rates close to 67%, while those requiring outflow tract visualization such as transposition of the great arteries have considerably lower rates of prenatal detection, 25%.…”

“…5 Prenatal detection rates remain poor for conditions such as total anomalous pulmonary venous return and aortic arch obstruction, due to fetal cardiac physiology and associated challenges with detection. [5][6][7] Neonates with C-CHD may present with a variety of findings that would warrant an echocardiogram, including tachypnea, cyanosis, and heart murmurs. However, these may not manifest until after 48 hours of life and therefore may be missed during the newborn hospitalization.…”

Evaluation of Circulating Cardiovascular Biomarker Levels for Early Detection of Congenital Heart Disease in Newborns in Sweden

“… 11 , 12 Critical CHD remains associated with risk of sudden cardiovascular collapse after discharge from maternity services. 11 , 13 Early postnatal detection of CHD can be improved through standardized clinical examination protocols, but evaluation of newborns with CHD requires clinical experience because of neonates’ transition from fetal to postnatal circulation. 14 Aortic arch obstructions from a slowly closing ductus arteriosus without apparent femoral pulse deficit or only mild cyanosis may go unnoticed.…”