ABSTRACT
Background: Delayed or missed diagnosis of critical and cyanotic congenital heart disease [CHD] in asymptomatic newborns may result in significant morbidity and mortality. The aim of this study was to determine the accuracy of pulse oximetry screening performed on the first day of life for the early detection of critical and cyanotic CHD in apparently normal newborns
Methods: This cross-sectional study used postductal pulse oximetry to evaluate term neonates born between 2008 and 2011 with normal physical examinations. Functional oxygen saturation < 95% was considered abnormal, and second measurement was done 2 hours later. If the second measurement remained < 95%, an echocardiogram was performed. On enrolment in the study, the following data for each neonate were recorded: gestational age, gender, birth weight, mode of delivery, and mother's age
Results: During the study period, totally 3,846 newborns were evaluated. Of the whole study population, 304 [7.9%] babies had a postductal functional saturation < 95%. The second measurement was also < 95% in 104 [2.7%] neonates. The mean age of the neonates at the time of pulse oximetry was 18.91 +/- 8.61 [min = 4.5 and max = 49] hours. Forty-nine percent of the subjects were female and 51% were male. Echocardiography was performed on 81 out of 104 newborns, and 14 [0.36%] of them had CHD. The types of CHD in our patients were tetralogy of Fallot [3 cases], transposition of the great vessels [2 cases], double-outlet right ventricle [2 cases], truncus arteriosus, total anomalous pulmonary venous return, atrioventricular septal defect, pulmonary atresia, persistent pulmonary hypertension, ventricular septal defect, and atrial septal defect [1 case for each type]. The best time for pulse oximetry was within 8-24 hours of the newborns' life
Conclusion: Pulse oximetry screening along with clinical examination may be able to assist in the early detection of critical and cyanotic CHD in asymptomatic newborns
ABSTRACT
Apparent Life-Threatening Events [ALTEs] is an episode that is frightening to the observer and is characterized by some combination of apnea, color change, altered muscle tone, choking, and gagging. This study was designed to evaluate and follow up neonates who presented with clinical manifestation of an ALTE in a year. In this prospective observational study, all of the neonates with episode of ALTE who were admitted to the Children's Medical Center [CMC] in Tehran, from June 15[th] 2010 to May 14[th] 2011 were enrolled in the study. Data from patients consisting of history, physical examinations, and paraclinical findings were recorded in a checklist and all followed up 3 to 6 months after discharge. During the study period 18 neonates were admitted due to ALTE episode[s] with mean age of 15 +/- 13 days. Nine [50%] neonates had previous attacks of ALTE. The most frequent complaint was cyanosis in 12 [67%] and apnea in 8 [44%] patients. In 10 [56%] the event lasted less than one minute, 13 [72%] were awake, 17 [95%] in supine position and 13 [72%] on their parent's lap. Primary antagonistic impression on admission was sepsis in 11 [61%] and concomitant seizure in 5 [28%]. The most common final diagnosis according to repeated physical examinations, result of paraclinical investigations and follow up was sepsis 4 [22%] and aspiration 9 [50%]. ALTE recurred in none of the neonates during follow up. The rate of ALTE seems to be higher than in this study owing to high incidence of recurrent ALTE. Although most of these attacks regress spontaneously, more attention should be paid for the underlying diseases