Sensibilidad y especificidad de la oximetría de pulso para detectarcardiopatías congénitas en recién nacidos / Sensitivity and specificity of pulse oximetry to detect congenital heart disease in newborns

Resumen Objetivo: Determinar la sensibilidad y especificidad de la oximetría de pulso, para detectar cardiopatías congénitas en recién nacidos sanos en alojamiento conjunto. Material y métodos: El estudio es de tipo multicéntrico, prospectivo y transversal, evaluando pacientes del Hospital Regional de Alta Especialidad "Bicentenario 2010" y el Hospital General "Dr. Norberto Treviño Zapata", en ciudad Victoria Tamaulipas, en un periodo que comprendió desde marzo del 2015 a marzo de 2017. Se determinó la oximetría de pulso a recién nacidos sanos antes del egreso hospitalario. Resultados: Se estudiaron 511 recién nacidos. La sensibilidad detectada fue del 88.89 % y una especificidad del 99.80%. Conclusión: Las cardiopatías congénitas en recién nacidos sanos en alojamiento conjunto, se pueden determinar mediante la oximetría de pulso pre y post-ductal.

Abstract Objective: To determine the sensitivity and specificity of pulse oximetry to detect congenital heart disease in healthy newborns in rooming-in. Material and methods: The study is multicenter, prospective and cross-sectional, evaluating patients from the Regional Hospital of High Specialty "Bicentenario 2010" and the General Hospital "Dr. Norberto Treviño Zapata", in the city of Victoria Tamaulipas, in a period from march 2015 to March 2017. Pulse oximetry was determined in healthy newborns before hospital discharge. Results: 511 newborns were studied. The sensitivity detected was 88.89% and a specificity of 99.80%. Conclusion: Congenital heart disease in healthy newborns in rooming-in can be determined by pre- and post-ductal pulse oximetry.

Arterial oxygen saturation in healthy Mexican full-term newborns at different altitudes above sea level / Saturación arterial de oxígeno en recien nacidos mexicanos a término sanos a diferentes altitudes sobre el nivel del mar

Abstract Background: Arterial oxygen saturation (SaO2) values are used to make clinical decisions that might change a patient's prognosis, and it has been proposed as the fifth vital sign. This study aimed to determine the variation of SaO2 at different altitudes above sea level (ASL) in healthy Mexican full-term newborns. Methods: From July 2018 to June 2019, a cross-over study was conducted in six hospitals at different altitudes ASL in Mexico. SaO2 was measured in 4015 newborns after the first 24 h of birth and before leaving the hospital using pulse oximetry. We analyzed three groups: < 250 m ASL (group 1), 1500 m ASL (group 2), and 2250 m ASL (group 3). Results: The mean SaO2 was 97.6 ± 1.8%. For group 1, mean oxygen saturation was 98.2 ± 1.9%; for group 2, 96.7 ± 1.9%, and for group 3, 96.0 ± 2.1%. A statistically significant difference was observed among the groups (p < 0.001), and this difference was higher between groups 1 and 2 (1.5%, p < 0.001). Linear regression analysis showed a decrease in oxygen saturation of 1.01% for every 1000 m ASL. Conclusions: We demonstrated a statistically significant reduction in SaO2 levels at higher altitudes. This observation can be relevant for clinical decision-making based on pulse oximetry such as critical congenital heart disease screening in Mexico, where more than half of the population lives above 1500 m ASL.

Resumen Introducción: Los valores de SaO2 (saturación de oxígeno) se utilizan para la toma de decisiones clínicas que podrían cambiar el pronóstico del paciente. El objetivo de este estudio fue determinar la variación de la SaO2 en recién nacidos mexicanos a término sanos a diferentes altitudes en México. Métodos: Se llevó a cabo un estudio transversal en seis hospitales situados a diferentes altitudes en México. Se determinó la SaO2 usando oximetría de pulso en 4015 recién nacidos después de las primeras 24 horas de vida, pero antes del egreso del hospital de nacimiento. Se formaron tres grupos para el análisis: grupo 1 con altitud < 250 m sobre el nivel del mar (SNM); grupo 2, altitud de 1500 m SNM y grupo 3, altitud de 2250 m SNM. Resultados: El promedio de la SaO2 fue de 97.6 ± 1.8%. Para el grupo 1, la media fue 98.2 ± 1.9%, para el 2, 96.7 ± 1.9% y para el 3, 96.0 ± 2.1%. Se observó una diferencia estadísticamente significativa entre los grupos (p < 0.001), que fue mayor entre los grupos 1 y 2 (1.5%, p < 0.001). El análisis de regresión lineal mostró una reducción de 1.01% en la SaO2 por cada 1000 m SNM. Conclusiones: Se demostró una disminución estadísticamente significativa de los valores de SaO2 conforme aumenta la altitud. Esto puede ser de particular relevancia en la toma de decisions clínicas basadas en la oximetría de pulso, como el tamiz neonatal cardiaco, sobre todo en México donde mas de la mitad de la población vive a una altitud superior a 1500 m SNM.

Construction and application of a screening system for neonatal congenital heart disease in Hainan Province / 中华实用儿科临床杂志

Objective:To assess the efficacy of the newly constructed system for screening, managing and monitoring congenital heart disease (CHD) in neonates of Hainan Province, thus providing references for a further promotion.Methods:Clinical data of neonatal CHD in Hainan Province from January 1, 2019 to December 31, 2021 were retrospectively analyzed, including screening, diagnosis and treatment, prognosis and follow-up.Relying on Hainan Women and Children′s Medical Center as the leading unit, a neonatal CHD screening, diagnosis, treatment, and monitoring system was established.A dual-indicator method was adopted, that was, screening staffs in Hainan Province performed CHD screening in living neonates by cardiac auscultation and pulse oximetry (POX) within 6-72 h after birth.Echocardiographic examinations for the screened living neonates were performed in the 31 authorized diagnosis institutions.Evaluations, interventions and treatment of living neonates with CHD were performed in 6 authorized tertiary hospitals.Data of screening, diagnosis, evaluation and treatment were filled in, uploaded and managed online through the neonatal CHD screening information management system.The research team of our hospital was responsible for the data management and monitoring.Results:From January 1 st, 2019 to December 31 st, 2021, there were 329 387 living neonates in Hainan Province, and 321 447 (97.59%) were screened for CHD, and the annual screening rate increased year by year.The positive rate of CHD screening was 2.50%(8 032/321 447). The rate of cardiac ultrasound examination within 1 week of CHD positive screening was 94.66%(7 603/8 032). The referral rate of severe CHD was 100.00%(154/154). The overall prevalence of CHD in neonates of Hainan Province was 3.419‰ (1 099/321 447). Atrial septal defect was the most common CHD lesion, with a proportion of 38.40%(422/1 099). The sensitivity of cardiac auscultation, POX and their combination for CHD detection were 69.15%, 33.49% and 91.90%, respectively, and the specificity were 98.36%, 99.43% and 97.81%, respectively.At the initial screening, the ratio of dual-positive of cardiac auscultation and POX in neonates with severe CHD (serious and critical CHD) was significantly higher than that of a single positive indicator ( χ2=36.502, 46.214, respectively; all P<0.001). All neonates with CHD were evaluated.Fifteen neonates with severe CHD died.From 2019 to 2021, the standardized mortality rate of children aged 0-1 years with CHD in Hainan province was 4.67/100 000 (15/321 447). Conclusions:Dual-indicator screening for CHD (cardiac auscultation plus POX) is reliable, non-invasive, and simple, which is conducive to be clinically promoted.Introducing and promoting an appropriate technology for screening, diagnosis, and evaluation of neonatal CHD are extremely significant since they may have contributed to the timely diagnosis and treatment of CHD, especially severe CHD, thus lowering the mortality.

Relation between Pulse Oximetry and the Clinical Profile of Children with Pneumonia

Background: Failure to seek early care and delays in hospital diagnosis are commonly acknowledged determinants of mortality in childhood pneumonia with a higher proportion specially in under developed countries like Bangladesh. Rather than detecting pneumonia by only signs, pulse oximetry may be a useful tool in ensuring the most efficient use of oxygen therapy, which is especially important in resource-limited settings. The aim of this study was to assess the relation between pulse oximetry and the clinical profile of children with pneumonia.Material & Methods:This cross-sectional type of descriptive study was conducted in Department of Pediatric, Rangpur Medical Collage and Hospital, Rangpur from July 2014 to June 2016. This study was carried out on 205 Children aged 2-59 months suffering from pneumonia inpatient and outpatient of Pediatric department.Results:It was observed that majority (91.7%) patients had cough184(89.8%) had breathing difficulty and 173(84.4%) patients had fast breathing. It was observed that majority (92.2%) patients had ability to cry while examined. Majority (90.7%) patients had crepitations. Three (1.5%) patients was found pallor of palms, 178 (86.8%) patients were heart rate ?100 beats per minute, 196(95.6%) were capillary refill time <3 second, 4(2.0%) hepatomegaly >2 cm and 131(63.9%) had temperature ? 38 °C. It was observed that Hypoxemia (?90%) was found 51(24.9%) of the patients. The mean SpO2 was found 88.6±4.7 percent with range from 70 to 99 percent.Conclusions:Cough, breathing difficulty and fast breathing are most common signs of children with pneumonia. Through pulse oximetry test, the prevalence of hypoxaemia was found in 24.9% children.

Effect of dental tissue thickness on the measurement of oxygen saturation by two different pulse oximeters

Abstract This study aimed to evaluate the influence of different dental tissue thickness on the measurement of oxygen saturation (SpO2) levels in high (HP) and low (LP) blood perfusion by comparing the values obtained from two different pulse oximeters (POs) - BCI and Sense 10. Thirty freshly extracted human teeth had their crowns interposed between the POs and an optical simulator, which emulated the SpO2 and heart beats per minute (bpm) at HP (100% SpO2/75 bpm) and LP (86% SpO2/75 bpm) modes. Afterwards, the palatine/lingual surfaces of the dental crowns were worn with diamond drills. The reading of SpO2 was performed again using the POs alternately through the buccal surface of each dental crown. Data were analyzed by the Wilcoxon, Mann-Whitney and Kendall Tau-b tests (α=5%). The results showed significant difference at the HP and LP modes in the SpO2 readouts through the different dental thicknesses with the use of BCI, and at the LP mode with the use of Sense 10, which had a significant linear correlation (p<0.0001) and lower SpO2 readout values in relation to the increase of the dental thickness. Irrespective of tooth thickness, Sense 10 had significantly higher readout values (p<0.0001) than BCI at both perfusion modes. The interposition of different thicknesses of enamel and dentin influenced the POs measurement of SpO2, specially at the low perfusion mode. The POs were more accurate in SpO2 measurement when simulated perfusion levels were higher.

Resumo Este estudo avaliou a influência de diferentes espessuras de esmalte e dentina na medição dos níveis de saturação de oxigênio (SpO2) em alta (HP) e baixa (LP) perfusão sanguínea, comparando os valores obtidos em dois oxímetros de pulso (OPs) diferentes, BCI e Sense 10. Trinta dentes recém-extraídos de humanos tiveram suas coroas interpostas entre os OPs e um simulador óptico, que simulava a SpO2 e os batimentos cardíacos por minuto (bpm) nos modos de HP (100% SpO2 / 75 bpm) e LP (86% SpO2 / 75 bpm). Após, as superfícies palatinas / linguais dos dentes foram desgastadas com brocas de diamantadas. A leitura da SpO2 foi realizada novamente usando os dois OPs alternadamente através da face vestibular de cada coroa dental. Os dados foram analisados ​​pelos testes Wilcoxon, Mann-Whitney e Kendall Tau-b (α = 5%). Os resultados mostraram diferença significativa nos modos HP e LP nas leituras de SpO2 através das diferentes espessuras dentárias com o uso do BCI, e no modo LP com o uso do Sense 10, que teve correlação linear significativa (p <0,0001) e menores valores de leitura de SpO2 em relação ao aumento da espessura dentária. Independentemente da espessura do dente, o Sense 10 apresentou valores de leitura significativamente maiores (p <0,0001) do que o BCI em ambos os modos de perfusão. A interposição de diferentes espessuras de esmalte e dentina influenciaram a mensuração da SpO2 pelos OPs, especialmente no modo de baixa perfusão. Os POs foram mais precisos na mensuração da SpO2 quando os níveis simulados de perfusão foram maiores.

Efficacious Continuous Monitoring of Infants Using Wireless Remote Monitoring Technology

Objective To compare postductal heart rate and saturation (SpO2) measurements from the wireless PO device obtained by iVital+against measurements by the standard Masimo (SET technology) monitor in the monitoring of neonates. Methods Pulse oximetry reading of newborns were assessed in terms of heart rate and saturations with two PO simultaneously attached to postductal site and data comparison was done. Results Out of the 1000 cumulative recordings, the mean diference between HR obtained from both PO was 0.415 and level of agreement was 2.3 beats per minute. For SpO2 mean diference between devices was 1.21 and level of agreement was 1.5%. There was very little diference between SpO2 measurements when the Masimo SpO2 was?70%. Conclusion As this pulse oximeter is small, portable and accuracy is as comparable to Masimo, this provides a good solution for efcaciously monitoring neonates. It can also be used in the monitoring of children with suspected or afected with COVID-19 in hospital and ICU settings as also in the quarantine facilities. This reduces the need for constant presence of medical and nursing personnel.

Oxygen Saturation in Neonate after Birth

Background: Oxygen saturation measures the quantity of haemoglobin in the blood that is saturated with oxygen. Hemoglobin is a component of red blood cells that binds oxygen and transports it to outlying tissues. Oxygen is commonly used throughout the world in neonatal units. Injudicious use of Oxygen may not maintain appropriate oxygen status rather can lead to hypoxemia or hyperoxemia, both of the conditions are injurious to neonatal health. Objective: To assess the oxygen saturation in neonate after birth.Methods:A cross-sectional study conducted in the Department of Neonatology BSMMU, Shahbag, Dhaka, Lab Aid Specialized Hospital, Dhaka, Bangladesh from October 2013 to March 2014. A total 317 patients were selected according to selection criteria. The parents were interviewed with a specific pre-designed and pre-tested questionnaire and some information were gathered by document review. All neonate both term and late preterm (?34weeks) who would not be anticipated for resuscitation was included.Results:A total 317 neonate were selected according to selection criteria. Among the study subjects more than half were male (57.1%). Rests were female (42.9%). Average gestational age of the study subjects was 37.47� 1.16 (SD) with the range of 34-40. On the other hand average birth weight was 2.88�46 (SD) with the minimum birth weight 2.0 kg and maximum weight 4.2 kg. Illustrates the median (IQR) heart rate from one to ten min for preterm versus term births. At one to three minutes and at five minutes after birth preterm infants had significantly lower SpO2 measurements. From six to 10 minutes after birth and four minutes after birth there was no significant difference between SpO2 measurements for mode of delivery. Paired sample t test showed that average SpO2 was less in 1 minute[88.42�8(SD)] than in 5 minute [94.25�5(SD)] and statistically this differences were highly significant (t=24.44, p=0.000). Pearson correlation showed high positive correlation (p=0.000) and correlation co-efficient r=0.479. Correlation was significant at the 0.01 level.Conclusion:It is 搉ormal� to have low oxygen saturation measurements in the first minutes after birth. It takes time for infants to reach oxygen saturation levels described as 搉ormal� in the later postnatal period. Oxygen saturation increased with time i.e., it was more in 5 minutes than in 1 minute and similarly more in 10 minutes than in 5 minutes. Conversely heart rate was found more in one minute than to five and ten minutes. Oxygen saturation was ? 90% within 3 to 4 minutes. Significant changes were found in Oxygen saturation by mode of delivery in three minutes & in heart rate by two minutes after birth. At one to ten minutes after birth preterm infants had lower SpO2 measurements.

Study on knowledge, attitudes and practices of pulse oximetry among pediatric healthcare providers in China and their influencing factors / 中华实用儿科临床杂志

Objective:To investigate the knowledge, attitudes, and practices (KAP) of pulse oximetry among pediatric healthcare providers in China and analyze the factor influencing the KAP.Methods:A self-developed questionnaire was used for an online research on the KAP of 11 849 pediatric healthcare providers from 31 provinces, autonomous regions, and municipalities of China from March 11 to 14, 2022.The factors influencing the KAP of pulse oximetry among pediatric healthcare providers were examined by Logistic regression. Results:The scores of KAP, of pulse oximetry were 5.57±0.96, 11.24±1.25 and 11.19±4.54, respectively.The corresponding scoring rates were 69.61%, 74.95%, and 55.99%, respectively. Logistic regression results showed that the gender and working years of pediatric healthcare providers, the region they were located, and whether their medical institution was equipped with pulse oximeters were the main factors affecting the knowledge score (all P<0.05). Main factors influencing the attitude score of pediatric healthcare providers included their knowledge score, gender, educational background, working years, region, medical institution level, and whether the medical institution was equipped with pulse oximeters (all P<0.05). For the practice score, the main influencing factors were the knowledge score, gender, age, and whether the medi-cal institution was equipped with pulse oximeters (all P<0.05). Conclusions:Chinese pediatric healthcare providers need to further improve their knowledge about and attitudes towards pulse oximetry.Pulse oximeters are evidently under-used.It is urgent to formulate policies or guidelines, strengthen education and training, improve knowledge and attitudes, equip more institutions with pulse oximeters, and popularize their application in medical institutions.

Expert consensus on clinical application of pulse oximetry in children / 中华实用儿科临床杂志

Hypoxemia is a common complication of pneumonia, asthma, and bronchopulmonary dysplasia in children.Rapid identification of hypoxemia is of great significance for the disposal and management of critical children.Pulse oximetry is recognized by the World Health Organization as the best way to monitor hypoxemia in children, and it can monitor pulse oxygen saturation noninvasively and continuously.Based on the related literature at home and abroad, combined with the clinical needs of pediatrics, the " Expert consensus on clinical application of pulse oximetry in children" is formulated to improve the understanding of pediatricians and nurses on the application in pediatric clinical practice, principle, operation techniques, and limitations of pulse oximetry.

Pulse oximeter as a home assessment tool: Knowledge and user experience among the community in Malaysia during the COVID-19 pandemic

Objective: To determine the degree of knowledge in the usage of pulse oximeter as a home assessment tool among the community in Malaysia. Methods: A cross-sectional survey was conducted in November 2021. The questionnaire assessed the knowledge in using pulse oximeters, user experience and opinions in using pulse oximeter as a home assessment tool during the pandemic. Results: A total of 504 respondents were included in the study, and the mean score in knowledge related to application of pulse oximetry was 73.00%, while the mean score in knowledge related to factors affecting pulse oximetry readings was only 38.51%. A total of 90.5% of the respondents recognised normal pulse rate and 88.5% knew the blood oxygen saturation levels of a healthy adult, while 69.4% recognised the definition of silent hypoxia. In addition, the majority of the respondents agreed that factors such as poor blood circulation (71.2%), excessive movements (69.8%), and hand position (60.7%) affected oximetry readings. However, 61.7%, 81.7%, 77.2% and 76.8% of the respondents could not identify nail polish, skin colour, skin thickness and tattoos as factors that may affect oximetry readings respectively. Conclusions: The respondents showed a satisfactory level of knowledge related to application of pulse oximetry, but a poor level of knowledge related to factors affecting pulse oximetry readings among the community in Malaysia. Continuous efforts in educating the community on the correct use of pulse oximeters are crucial for appropriate home assessment and avoiding unnecessary stress.

The correlation between carotid blood flow and the parameters derived by pulse oximetry plethysmographic waveform during cardiopulmonary resuscitation in a porcine model / 中华急诊医学杂志

Objective:To explore the correlation between carotid blood flow and the parameters derived by pulse oximetry Plethysmographic waveform in cardiopulmonary resuscitation, so as to provide a new index for carotid blood flow monitoring in cardiopulmonary resuscitation.Methods:Seven male domestic pigs were utilized for cardiac arrest model through ventricular fibrillation induced by electrical stimulation. Eight minutes after cardiac arrest, artificial chest compression was given for 4 min, and epinephrine 20 μg/kg was injected intravenously at 2 min after chest compression. The compression frequency, compression depth, right carotid blood flow, pulse oximetry plethysmographic waveform, aortic pressure, right atrium pressure and end tidal carbon dioxide partial pressure were continuously monitored and recorded. From 30 s to 4 min after chest compression, the values of the mean right carotid blood flow, the area under curve (AUC) of pulse oximetry plethysmographic waveform, the mean perfusion index, the mean coronary perfusion pressure and the average end-tidal carbon dioxide partial pressure during 6 s before time point were calculated every 30 s. The correlations between right carotid blood flow and the AUC of pulse oximetry plethysmographic waveform and perfusion index were analyzed respectively.Results:Ventricular fibrillation was induced successfully in seven animals. There were no significant differences in the mean chest compression frequency and depth per min during 4 min of chest compression. Right carotid blood flow at 30 s after chest compression was (92.7±32.7) mL/min, and decreased to (48.5±23.5) mL/min at 1 min after chest compression ( P<0.05). There was no significant difference in blood flow before and after epinephrine injection ( P>0.05). The AUC of the blood oxygen plethysmographic waveform and perfusion index showed synchronous change trends with right carotid blood flow. Both coronary perfusion pressure and end-tidal carbon dioxide partial pressure showed different change trends with right carotid blood flow. There was a positive correlation between the right carotid blood flow and the AUC of blood oxygen plethysmographic waveform ( r=0.66, P<0.01), and also a positive correlation between right carotid blood flow and perfusion index ( r=0.57, P<0.01). Conclusions:Carotid blood flow is positively correlated with the AUC of blood oxygen plethysmographic waveform and perfusion index in a porcine model of cardiopulmonary resuscitation. Real-time monitoring of the two parameters derived by pulse oximetry plethysmographic waveform can reflect the changes of carotid blood flow to a certain extent.

Tamizaje con oximetría de pulso en el diagnóstico de cardiopatías congénitas críticas en recién nacidos / Pulse oximetry screening in the diagnosis of critical congenital heart diseases in newborns

Resumen Objetivo Describir los resultados del tamizaje con oximetría de pulso en el diagnóstico de cardiopatías congénitas críticas en recién nacidos a término y asintomáticos, en una institución de salud de la ciudad de Cúcuta, durante el año 2018. Método: Se llevó a cabo un estudio de tipo descriptivo, de corte transversal, con recolección de información de manera prospectiva, en el cual se tomó oximetría de pulso a 438 recién nacidos a término, asintomáticos, que se encontraban en el quinto piso del Hospital Universitario Erasmo Meoz entre las 18 y las 48 horas de vida. Resultados El tamizaje fue negativo en un 99.1% de los recién nacidos y positivo en el 0.91%; este porcentaje corresponde a cuatro pacientes a quienes se les solicitó valoración por cardiología pediátrica y ecocardiograma transtorácico, de los cuales uno de ellos fue diagnosticado con transposición de grandes arterias y otro con hipertensión pulmonar moderada, y los dos pacientes restantes fueron sanos y dados de alta. Conclusiones La oximetría de pulso como prueba de tamizaje entre las 18 y las 48 horas de vida fue fundamental para diagnosticar una transposición de grandes arterias en un recién nacido asintomático, permitiéndole un tratamiento oportuno para una patología que representa un gran impacto en la morbimortalidad neonatal. Además, permitió el diagnóstico de hipertensión pulmonar en uno de los neonatos.

Abstract Objective To describe the results of pulse oximetry screening in the diagnosis of critical congenital heart diseases in newborns, in a health institution in Cucuta city, during 2018. Method A descriptive, cross-sectional study was conducted, with information collection prospectively, in which pulse oximetry was taken of 438 asymptomatic newborns at term who are on the fifth floor of the Erasmo Meoz University Hospital between 18 and 48 hours of life. Results Screening was negative in 99.1% of newborns and positive in 0.91%, this percentage corresponds to 4 patients who were asked for evaluation by pediatric cardiology and transthoracic echocardiogram; one of them was diagnosed with transposition of the great arteries, other with moderate pulmonary hypertension, the remaining two patients were healthy and discharged. Conclusions Pulse oximetry as a screening test between 18 and 48 hours of life was essential to diagnose a transposition of the great arteries in an asymptomatic newborn, allowing timely treatment for a pathology that represents a great impact on neonatal morbidity and mortality. Additionally, it allowed the diagnosis of pulmonary hypertension in one of the neonates.

Pulse Oximetry a Non-Invasive Screening Test to Intensify Primary Diagnosis of Critical Cyanotic Congenital Heart Disease in Neonates- A Retrospective Study.

Pulse oximetry is an important screening technique to intensify timely diagnosis of critical cyanotic congenital heart disease in neonates which is a noninvasive, safe and an easy method. It is a highly specific test having low false positive rates. This screening test was conducted in Department of Pediatrics, Darbhanga Medical College & Hospital, Laheriasarai, Darbhanga, Bihar, between 24 hours and 36 hours after birth, with use of the right hand of infants and either foot to diminish false positive results.METHODSData for study has been collected from birth records from Darbhanga Medical College & Hospital, Bihar, and included- 1. saturation level from either feet and right hand for the primary and further recurrence of screening. 2. outcomes of the echocardiographic test findings. 3. important non-cardiac illness diagnosed at the hospitalization for infants which failed screening for cyanotic CHD. For the correction of errors related to data of the study, we satisfied autonomous investigations of pulse oximetry requiring AAP CCHD screening algorithm to identify infants to pass with a saturation ≥95% in hand or either foot and a ≤3% difference and those falling after finishing 3 transitional screening tests. After three consecutive measurements, there is difference of SpO2 of more than 3% between pre-ductal and post-ductal SpO2.RESULTSThe combination of pulse oximetry and physical examination improved the sensitivity to up to 57.14% with a specificity of 99.73%. The overall mortality rate of CCHD was 36.8% [7 out of 19]. The mortality rate of early detection were 37.5% [6 out of 16]. Late detection of CCHD has mortality rate of 33.3% [1 out of 3]. 123 [13.1%] and 70 [7.4%] newborns have either foot or right hand SpO2 level < 95% among 941 study newborns at the time of the initial screening. The mean SpO2 level of either feet and right arm of study newborns were 95.8% [SD 2.3] and 96.0% [SD 2.2] respectively. Either feet and right arm level of SpO2 <95% and either feet to right arm level of SpO2 difference of >3% among 142 [15.1%] study newborns.CONCLUSIONSPulse oximetry screening for primary diagnosis of critical cyanotic CHD is an easy, economical and non-invasive test which covers the essential criteria in addition to worldwide newborn screening panel. Extensive approval and implementation can considerably reduce the morbidity in newborns infants and is likely to be an additional important tool in low resource settings where most of newborn infants are born without prenatal diagnosis. Although, this study showed reduced sensitivity of pulse oximetry for critical cyanotic CHD nearly <50%.

Pattern of Congenital Heart Disease in Newborn at a Tertiary Care Hospital

Background: Congenital heart disease (CHD) has been defined as a gross structural abnormality of the heart or intrathoracic great vessels that are actually or potentially of functional significance. CHD accounts for about 10% of newborn deaths and nearly half of all deaths due to congenital malformations in developed countries. The vast majority of newborns escape early intervention. The most important role of a pediatrician today is to ensure that, as far as possible, serious CHD should not be missed, especially in the neonatal period and infancy where maximum attrition for CHD occurs. Objective: The objective of the study was to identify the pattern of CHD using echocardiography in newborns born in a tertiary care hospital in Tamil Nadu. Methodology: A cross-sectional observational study conducted for 1 year. One hundred and fifty newborns diagnosed to have CHD after they underwent routine clinical examination and pulse oximetry, followed by echocardiography, were included in this study. Study design: This is a cross-sectional study. Place of study: Government Theni Medical College. Study period: 1 year. Sample size: 150. Inclusion Criteria: Newborns diagnosed to have CHD confirmed with echocardiography were included in this study. Exclusion Criteria: Newborns whose parents refused to provide consent were excluded from the study. Results: This study group includes 56% of girls and 44% of boys. It shows that 83% are term babies and the remaining 17% from preterm groups. Among these, 146 babies had acyanotic heart disease as 97% and rest four newborns as 3% had cyanotic disease. Among 146 acyanotic heart disease, 76 newborns (52%) had atrial septal defect (ASD), followed by patent ductus arteriosus (PDA) in 59 newborns (40%), ventricular septal defect (VSD) in 15 newborns (10%), pulmonary hypertension in eight newborns (5%), and magnetic resonance in only one newborn (0.6%). Among four newborns presented with cyanotic heart disease, two newborns presented with total anomalous pulmonary venous connection (50%), followed by transposition of great arteries (25%) and tetralogy of Fallot TOF (25%). Conclusion: In our study, the pattern of CHD is ASD, followed by PDA and VSD.

Clinical profile and outcome of congenital cyanotic heart disease in neonatal period: a retrospective study

Background: Congenital Cyanotic Heart Disease (CCHD) is under reported during neonatal period and mortality rate is high in India. Aims and objectives of the study determine clinical presentation, maternal and neonatal risk factors and outcome of CCHD during neonatal period.Methods: A retrospective study conducted over 15-month period during March 2017 to June 2018 in a tertiary out born NICU. Neonates with echocardiographically confirmed case of structurally abnormal heart disease were analyzed.Results: Among 106 CCHD neonates, 60% neonates were asymptomatic, 22% had persistent cyanosis and 19% had tachypneic at birth. Cyanosis (35%) and tachypnea (30%) were common initial presentation in postnatal period. 22% neonates were readmitted with initial clinical symptom after discharge from birthing centre. CCHD were more common in male and term neonate, 34% were small for age, median age at admission and discharge were 5days (2-12) and 5 days (2.7-9.2) days respectively. Nineteen percent neonates had fetal distress and 6% neonates required aggressive resuscitation at birth. First trimester abortion (16%), maternal diabetes (10%) and hypothyroidism (7%) were common maternal risk factor. Nearly 20% neonates were diagnosed at referring hospital and 4.7% were transported with PGE1 during transport. TGA (17%) was most common lesion noted followed by pulmonary atresia (10%). Fourteen percent neonates died during the neonatal period. Disease specific death rate was highest for Single ventricle (42%) followed by TGA with IVS (37.5%) and aortic arch anomaly (28.5%) in this study.Conclusions: Early diagnosis and management may improve the survival in CCHD neonates.

Prevalence of hypoxaemia and its associated factors in children with pneumonia seen at a tertiary hospital in Southeast Nigeria

Background: Hypoxaemia is a common complication and a significant predictor of death from pneumonia in children under five years of age. Knowledge of the prevalence of hypoxaemia and clinical signs associated with it may guide use of oxygen in the management of childhood pneumonia in resource-poor settings. This study was carried out to determine the prevalence of hypoxaemia in children with pneumonia and assess the relation between hypoxaemia and age, duration of illness and clinical signs.Methods: This was a descriptive cross-sectional study undertaken between 1st July 2016 and 27th April 2017. Children with pneumonia, aged 2-59 months, who attended Federal Medical Centre, Owerri and met the inclusion criteria, were recruited into the study. Subject evaluation included history and physical examination. Their blood oxygen saturation was determined by pulse oximetry and value less than 90% indicated hypoxaemia.Results: Out of the 144 children with pneumonia, 93(64.6%) were males and 51(35.4%) females giving a male to female ratio of 1.8:1. Median age was 8 months and mean weight (SD) was 8.6 kg (3.6). The overall prevalence of hypoxaemia was 17.4%. Hypoxaemia prevalence was significantly higher in infants (p=0.026) and severe pneumonia (p<0.0001). There was statistically significant association between hypoxaemia and lower chest in-drawing, nasal flaring, suprasternal recession, grunting, lethargy, tachypnoea and tachycardia. With adjustment for confounding variables, only lower chest in-drawing (OR: 9.672; p=0.004), lethargy (OR: 8.103; p=0.020) and grunting (OR: 4.960; p=0.050) predicted hypoxaemia in pneumonia. Each of these signs had a poor combination of sensitivity and specificity.Conclusions: Hypoxaemia is common in childhood pneumonia. Though some clinical signs are significantly associated with hypoxaemia in childhood pneumonia, they may be unreliable in predicting hypoxaemia. Therefore, pulse oximeters should be provided in every health facility for accurate detection of hypoxaemia.

Fractura supracondílea de húmero y extremidad sin pulso. Uso de oximetría de pulso como predictor de lesión vascular en un caso pediátrico / Pulseless limb and supracondylar humeral fracture; use of pulse oximetry as a predictor of vascular injury in a pediatric case

Las fracturas supracondíleas del húmero (FSCH) representan la segunda lesión más frecuente en la infancia. La clasificación de Gartland, de acuerdo con la dirección y magnitud del desplazamiento orienta hacia su tratamiento. Las fracturas grado I solo requieren inmovilización y los grados del II al IV necesitan reducción generalmente cerrada, y fijación con agujas de Kirschner percutáneas. En los grados III y IV las lesiones neuro-vasculares se pueden presentar debido a las relaciones anatómicas de la fractura. La lesión vascular se debe sospechar y tener siempre en cuenta, debido a las secuelas que se pueden presentar de no tomar una conducta adecuada a tiempo. Actualmente existe controversia acerca de cuándo realizar la exploración quirúrgica ante una extremidad bien perfundida, sin pulso radial como resultado de una FSCH. Varios autores han reportado la utilidad de la onda de pulso en la oximetría como predictor de lesión vascular. En este artículo se presenta un caso clínico de FSCH con extremidad sin pulso y lesión de la arteria braquial, su manejo y evolución final.

Supracondylar fractures of the humerus are the second most frequent lesion of infancy. Gartland's classification uses the direction and magnitude of the displacement to determine its treatment. Grade I fractures need only immobilization and grades II to IV need reduction, generally closed, and percutaneous fixation with Kirschner needles. Neurovascular lesions may be present in grades III and IV because of the anatomic relations to the fracture. Vascular injury must always be suspected and taken into consideration because of the sequelae that may occur if not given adequate treatment promptly.There is currently controversy over when to do a surgical exploration in a well-perfused limb with absent radial pulse resulting from a supracondylar humeral fracture. Several authors have reported the usefulness of the waveformof the pulse oximeter in predicting vascular injury. In this article we present a clinical case of supracondylar humeral fracturewithpulseless limb and brachial artery injury, its management, and the outcome.

The accuracy of the Innovo Deluxe Fingertip Pulse Oximeter perfusion index in predicting hypotension during balanced general anesthesia induction – A prospective observational study / The Health Sciences Journal

INTRODUCTION@#Balanced general anesthesia technique is a popular choice for induction because it can minimize potential side effects from individual drugs when otherwise used alone. However, hypotension is still a common occurrence during induction. Perfusion Index (PI) has been used as a measure of systemic vascular resistance and has shown to predict hypotension after regional anesthesia and propofol induction. This study aimed to determine whether baseline PI can predict hypotension following balanced general anesthesia induction and determine a cut-off value where hypotension is expected to occur.@*METHODS@#Thirty-five ASA I/II adults for elective surgery under general anesthesia were enrolled. Heart rate, blood pressure and PI were measured every minute from baseline to 5 minutes following induction and 10 minutes after endotracheal intubation. Hypotension was defined as fall in systolic BP (SBP) by >30% of baseline and/or mean arterial pressure (MAP) to <60 mmHg. Severe hypotension (MAP of <55 mm Hg) was treated. @*RESULTS@#No hypotension was observed in the first 5 minutes. Within 10 minutes, hypotension occurred in 8.6% by SBP criterion and 2.6% by MAP criterion. Within 15 minutes, hypotension was seen in 5.7% by SBP and MAP criterion, respectively. PI showed very low (r < 0.2) to low (r = 0.2 to 0.39), negative to positive and insignificant correlation (p > 0.05) with hypotension whether using SBP or MAP criterion and whether observed at 10 or 15 minutes of anesthesia induction. The Area under the ROC curve is 0.397, 95% CI [0 .126, 0.667], p = 0.431.@*CONCLUSION@#This study lends inconclusive evidence on the usefulness of Innovo Deluxe Fingertip Pulse Oximeter with Plethysmograph and Perfusion Index to predict intraoperative hypotension following balanced general anesthesia induction for this sample of patients. However, there was a positive, moderate (r=0.538, 0.501 and 0.469) and significant (p<0.05) correlation between perfusion index and SBP, Diastolic BP and MAP, respectively.

Del soplo inocente a la hipertensión arterial pulmonar / From an innocent heart murmur to pulmonary arterial hypertension

Resumen Introducción: La detección de cardiopatías congénitas en la etapa neonatal a partir de un soplo cardiaco o cianosis no es efectiva. Las cardiopatías congénitas críticas, como el tronco arterioso común (TAC), causan la mayoría de las muertes neonatales por malformaciones congénitas. El tamizaje por oximetría de pulso en los recién nacidos detecta hasta el 70% de estas cardiopatías. El TAC presenta una alta mortalidad en el primer año de vida. Caso clínico: Se presenta el caso de un paciente de sexo femenino de 4 años de edad con soplo cardiaco, palpitaciones, disnea y cianosis perioral, con diagnóstico al nacimiento de soplo inocente. Se detectó TAC mediante una ecocardiografía. Las resistencias vasculares pulmonares fueron evaluadas por medio de cateterismo cardiaco derecho, con hallazgo de hipertensión arterial pulmonar y vasorreactividad pulmonar. Se realizó corrección quirúrgica. A la fecha, la hipertensión arterial pulmonar continúa presente, por lo que se implementó Bosentan® (Actelion, USA) como tratamiento a largo plazo. Conclusiones: En recién nacidos, el tamizaje por oximetría de pulso después de las 24 horas de vida es un método efectivo para el diagnóstico oportuno de cardiopatías congénitas críticas antes de los signos de colapso cardiovascular. Por ello, resulta una herramienta diagnóstica fundamental para reducir la morbimortalidad. Aunque la corrección quirúrgica de cardiopatías congénitas con hipertensión arterial pulmonar es factible en algunos pacientes, su manejo subsecuente es complejo e impacta de manera adversa en la calidad de vida.

Abstract Background: The detection of congenital heart disease in newborns, based on a heart murmur or cyanosis is not effective. Critical congenital heart diseases, such as truncus arteriosus (TA), cause most of neonatal deaths due to congenital malformations. The screening for pulse oximetry in newborns detects up to 70% of these heart diseases. TA presents high mortality in the first year of life. Case report: A 4-year-old female patient with a heart murmur, palpitations, dyspnea, and perioral cyanosis was diagnosed with an innocent heart murmur at birth. TA was detected by echocardiography. Pulmonary vascular resistances were evaluated through right cardiac catheterization, and pulmonary arterial hypertension and pulmonary vasoreactivity were diagnosed as well. Surgical correction was performed. Currently, pulmonary arterial hypertension persists, for which Bosentan® (Actelion, USA) has been implemented as a long-term treatment. Conclusions: In newborns, the pulse oximetry screening after 24 hours of life is an effective method for suitable diagnosis of critical congenital heart disease before the signs of cardiovascular collapse. Therefore, it has become an essential diagnostic tool to reduce morbidity and mortality. Although the surgical correction of congenital heart disease with pulmonary arterial hypertension is feasible in some patients, its subsequent management is complex and has an adverse impact on the quality of life.

Saturación arterial de oxígeno y frecuencia cardíaca en recién nacidos de término sanos durante la primera hora post nacimiento / Arterial oxygen saturation and heart rate in term newborn in the first hour after birth

INTRODUCCIÓN: El oxímetro de pulso ha sido útil en la evaluación cardiorrespiratoria del neonato. OBJETIVO: Evaluar la saturación arterial de oxígeno (SpO2) y frecuencia cardíaca (FC) en recién nacidos (RN) en los pri meros 60 minutos después del nacimiento. PACIENTES Y MÉTODO: Estudio observacional prospectivo en RN de término sanos, nacidos por vía vaginal o cesárea, con apego materno, efectuado a nivel del mar. Se obtuvo registro continuo de SpO2 post-ductal y de FC desde el minuto 1 al 10 post-natal, y luego a los 15, 30 y 60 minutos. La SpO2 y FC se midieron con un oxímetro de pulso Nellcor. Para el análisis estadístico se utilizó programa Stata v.14. RESULTADOS: Se enrolaron 324 RNT sanos, que cum plieron criterios de inclusión, de los cuales 160 nacieron por vía vaginal y 164 por cesárea. La SpO2 aumentó progresivamente desde el minuto 1 (58,7%) hasta el minuto 10 (94,5%). Los RN por vía vaginal presentaron una SpO2 significativamente mayor hasta el minuto 10 post-natal respecto a los nacidos por cesárea (p < 0,001). En los neonatos nacidos por vía vaginal, la FC fue significativamente mayor en los 2 primeros minutos post-natales, y luego desde el minuto 10 al 60 (p < 0,003). No se encontraron diferencias por género en SpO2 y FC. CONCLUSIÓN: En RNT la SpO2 post-natal aumenta progresivamente, siendo mayor en los primeros 10 minutos en los nacidos por vía vaginal. En los RN por vía vaginal se observó también una FC mayor en los primeros y últimos minutos evaluados.

INTRODUCTION: The pulse oximeter has been useful in the cardiorespiratory evaluation of the newborn. OBJECTIVE: To assess arterial oxygen saturation (SpO2) and heart rate (HR) in newborns in the first 60 minutes after birth. PATIENTS AND METHOD: Prospective observational study in healthy term newborns, delivered vaginally or by cesarean section, with maternal bonding, carried out at sea level. A continuous post ductal SpO2 and HR record were obtained from minute 1 to 10 after birth, and then at 15, 30 and 60 minutes. The SpO2 and HR were measured with a Nellcor pulse oximeter. The software Stata v.14 was used for the statistical analysis. RESULTS: 324 healthy term newborns that met the inclusion criteria were included, of which 160 born vaginally and 164 by cesarean section. The SpO2 increased progres sively from minute 1 (58.7%) to minute 10 (94.5%). Newborns delivered vaginally had a significantly higher SpO2 until minute 10 after birth than those born by cesarean section (p < 0.001). In newborns delivered vaginally, HR was significantly higher in the first two minutes after birth, and then from minute 10 to 60 (p < 0.003). There were no differences by gender in SpO2 and HR. CONCLUSION: In term newborns, the SpO2 increases progressively, being higher in the first 10 minutes in those born vaginally. In newborns delivered vaginally, a higher HR was also observed in the first and last minutes evaluated.