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Background: Newborn pulse oximetry screening at 24-48 hours of life is recommended to detect critical congenital heart disease (CCHD), but cyanosis can also be due to pulmonary pathology and neonatal infections. Infants born out of hospital often lack a prenatal assessment with ultrasound, have variable rates of maternal GBS testing, and are typically observed only for a few hours after delivery, necessitating a modified pulse oximetry screening protocol.
Methods: Infants had pulse oximetry screening at 1-3 hours of life (“early screen”) and again at 24-48 hours (“standard screen”) by trained midwives. Midwives were provided training and reliable pulse oximeters (Massimo) to perform the screening. The current AAP-endorsed algorithm for interpreting results was used at both screenings. Midwives followed infants for at least 6 weeks to identify any missed cardiopulmonary pathology or infectious illnesses.
Results: 399 term infants (52% male, average weight 8.0 ± 1 pounds) were screened following parental consent. Prenatal ultrasound was completed for 45% of infants with no CHD identified. 65% of mothers were tested for GBS colonization and 22% of those tested were positive. Early and standard screens were performed and interpreted correctly for 74% and 79% percent of infants, respectively. The early screen identified one newborn with CHD (0.25% positive rate). An additional infant with CHD was identified due to inability to obtain a reliable reading at the early screen and murmur and poor feeding at standard screen. One newborn failed the standard screen but further evaluation was deferred and the infant remained well (false positive rate 0.25%). At 6 week follow up no additional cardiopulmonary pathology or infections were detected in the cohort.
Conclusions: Preliminary data suggest a combined early and standard newborn pulse oximetry screen can be implemented to detect CHD in out of hospital births with a low false positive rate. Midwives have varied levels of education and training therefore may have a learning curve to implement the protocol accurately. Ongoing study will determine if this is an effective “wellness screen” to detect any additional pulmonary pathology and neonatal infections.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Congenital Heart Disease: New Diagnostic Approaches in Congenital Heart Disease
Abstract Category: 10. Congenital Heart Disease: Pediatric
Presentation Number: 1231-011
- 2017 American College of Cardiology Foundation