Screening for Congenital Heart Disease

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SCREENING FOR CONGENITAL HEART DISEASE BY
PULSE OXIMETRY IN ASYMPTOMATIC NEWBORNS.

• Amir Hosein Movahedian M.D. Pediatric
  Cardiologist
• Ziba Mosayebi M.D.
• Neonatologist

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Congenital Heart Disease

• The most common form of major birth defect
• Six times more common than chromosomal
  abnormalities
• Four times more common than neural tube defects

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Congenital Heart Disease

• Incidence 8/1000 live birth
• Account for approximately 40 of perinatal death
• More than 20 of deaths in first month of life
  and the majority of deaths from congenital
  defects in childhood
• Place a significant economic burden on ministry
  of health and society and psychological wellbeing
  of affected families

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• Newborn screening is an essential preventive
  public health program
• For nearly 40 years, newborn screening program
  have provided an important public health service
  by identifying newborns with congenital condition
  that could be managed effectively with
  intervention early in life

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• The effectiveness of a screening program is
  dependent on
• Prevalence of the disorder of interest
• Simple and reliable methods
• Available treatment
• Favorable cost/benefit ratio

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Methods of Screening for CHD

• Fetal Echocardiography
• Physical Examination
• Echocardiography
• Pulse Oximetry

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Fetal Echocardiography

• Indications
• A parent with a Hx of CHD.
• A Hx of previous children with CHD.
• The presence of fetal cardiac arrhythmias.
• The presence of certain maternal disease.
• The presence of chromosomal anomalies.
• The presence of extracardiac anomalies.
• The presence of polyhydramnious or
  oligohydramnios.
• A history of maternal exposure to certain
  medication.

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Physical Examination

• When examining a newborn infant, keep in mind
  that about one third of the infants who prove to
  have important congenital heart disease may be
  discharged as apparently well from maternity
  hospital.
• The diagnosis of CHD is established by
• 1 week in 40-50, by 1 month in 50-60, by 1 year
  in 88 and by 4 year in 99.
• 
  (continued)

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Physical Examination

• Among 1067 babies with CHD who had a routine
  newborn examination 870 (82) were not recognized
  to have CHD before hospital discharge .

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Echocardiography

• A study was conducted on 9697 deliveries in a
  hospital in Belfast (1994-98).
• Scan group 4875
• 124 CHD before discharge
• 1 CHD in F/U
• Clinical assesment group 4822
• 50 CHD before discharge
• 27 CHD in F/U

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Objective

• Many newborns with CHD are not detected in
  nursery and undiagnosed CHD is an important
  source of morbidity and mortality
• The objective of this study was to assess the
  usefulness of pulse oximetry (POx) screening for
  an early detection of congenital heart disease in
  otherwise healthy neonates.

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Method

• Oxygen saturation was measured over two minutes
  in right foot of all newborns not admitted
  directly to neonatal unit during a one year
  period .

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Method

• Babies with functional oxygen saturation below
  95 considered abnormal. A second saturation
  measurement was performed 2 hours later . If
  repeated measurement was again below 95 an
  echocardiogram was performed.

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Results

• ?During a one year period(December 2004-December
  2005)4461 newborns were delivered in kashan city
  with a population of about 400000. A total of
  3846 newborns were screened
• ( Figure 1).

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Figure 1POx values and progression of
investigation .

• 
  4461
• 615
  
  3846
• missed
  saturation measured
  saturation
  not measured
• (neonatal unit admission , no consent, )
• 
  
• 
  3542
  304
• 
  saturation normal
  saturation low
• (POxgt95)
  
  (POxlt95)
• 
  
  Repeat saturation
  
• 
  200
  104
• saturation
  normal
  saturation low
• 
  
  echocardiography
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  67
  14
• missed
  normal
  CHD

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Results

• A postductal functional saturation of less than
  95 was found in 304 (7.9) cases. In 104 (2.7)
  babies a second measurement was also less than
  95, echocardiography was performed on 81/104 of
  whom 14 (0.36) cases had CHD . In our study we
  found more patients with CHD when we performed
  Pox measurement in the first 24 hr of life
  (table 1).

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Table 1The result of echocardiography according
to the time of POx measurement.
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Results

• The characteristic of patients and the types of
  CHD are shown in table 2.

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Table 2 Saturation of newborns with CHD (n14) .

• Patient Sex Age(hr) 2nd
  Saturation Diagnosis
• 1. M 26
  82 VSDPH
• 2. M 14
  77 ASDPH
• 3. M 9
  82 PPHN
• 4. M 21
  87 DORVVSDPS
• 5. F 8
  91 SVTGA
• 6. F 9
  87 VSDPA
• 7. F 15
  93 TF
• 8. F 10
  94 TA
• 9. M 18
  92 TF
• 10. F 16
  94 TF
• 11. F 16
  84 TAPVR
• 12. M 10
  75 TGAIVS
• 13. F 12
  85
  DORVVSDTGA
• 14. F 12
  80 AVSDPA
  
• PA Pulmonary atresia , TA Truncus arteriosus
  , IVS Intact ventricular septum.

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Conclusion

• Pulse oximetry is a noninvasive screening tool
  for early detection of CHD. We suggest it should
  be a part of discharge exam for all the
  asymptomatic newborns.

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Thank you for your attention