Pulse Oximetry and Congenital Heart Disease Screening: Results of the First Pilot Study in Morocco

Abstract

<jats:p>Congenital heart disease (CHD) is the most common congenital malformation. Diagnosis of critical congenital heart disease (CCHD), the most severe type of congenital heart disease, in a newborn may be difficult. The addition of CCHD screening, using pulse oximetry, to clinical assessment significantly improves the rate of detection. We conducted a pilot study in Morocco on screening neonates for critical congenital heart disease. This study was conducted in the maternity ward of Mohammed VI University Hospital of Marrakesh, Morocco, and included asymptomatic newborns delivered between March 2019 and January 2020. The screening of CCHD was performed by pulse oximetry measuring the pre- and post-ductal saturation. Screening was performed on 8013/10,451 (76.7%) asymptomatic newborns. According to the algorithm, 7998 cases passed the screening test (99.82%), including one inconclusive test that was repeated an hour later and was normal. Fifteen newborns failed the screening test (0.18%): five CCHD, five false positives, and five CHD but non-critical. One false negative case was diagnosed at 2 months of age. Our results encourage us to strengthen screening for CCHD by adding pulse oximetry to the routine newborn screening panel.</jats:p>

Newborn Critical Congenital Heart Disease Screening Using Pulse Oximetry: Value and Unique Challenges in Developing Regions

“…A stated goal of the pilot was to improve the early detection of CCHD to enable better management. It is significant to note that similar to what Singh and colleagues [ 14 ] found in their retrospective review of CCHD pulse oximetry screening in the United Kingdom, where 79% of screening test positives identified significant clinical conditions, in the Morocco pilot, 86.7% (13/15 positive test results) of test positives identified important pathologies including five CCHD, five CHD, one PPHN, and two cases of neonatal sepsis [ 11 ].…”

“…This is particularly true as 40 of the 50 countries with the highest fertility rates are in Africa [ 10 ]. Additionally, the MENA region is associated with large family sizes and high levels of consanguinity [ 10 , 11 ]. Factors, including providing participants a venue to discuss, learn from international experts, and discover opportunities (based on recent advances in research and technology), were interwoven with providing a platform in which to discuss common challenges and share updates on implementation and successful intervention programs.…”

“…Another unique manuscript included is the first CCHD screening feasibility pilot study conducted in Morocco, a country whose challenges include significant neonatal mortality (total overall neonatal mortality in the Marrakesh region is approximately 16 infant deaths per 1000 live births) [ 11 ], limited access to cardiovascular surgery, and ongoing efforts to develop pediatric cardiac intensive care expertise [ 11 ]. Telemedicine echocardiography consultations helped address the challenging need for access to specialists not available locally.…”

The Importance of Screening Critical Congenital Heart Disease By Pulse Oximetry During Routine Neonatal Examination; Two Cases Reports

“…6 Prenatal ultrasound in some studies still detects less than 50% of the cases of CCHD. 7 Although the prevalence of CCHD is only 25% of congenital heart diseases, timely diagnosis is crucial to prevent mortality, and morbidity. 8 A retrospective data analysis from America estimated that 23% (n=825 in 3603) of infants with CCHD were not diagnosed by clinical examination during their birth hospitalization.…”

Newborn Screening for Critical Congenital Heart Disease in a Low-Resource Setting; Research Protocol and Preliminary Results of the Tanzania Pulse Oximetry Study

“…In a low-resource setting, POX adoption is debatable. Adequate evidence doesn’t exist yet to support POX feasibility and the capacity of health systems to handle an additional screening task to add on to the already burdened health-care services [ 13 14 15 ]. These reasons highlight on the criticality of this debate for sub-Saharan Africa less developed health systems.…”