Clinical Screening for Congenital Heart Disease at Birth: A Prospective Study in a Community Hospital in Kerala.
Indian Pediatr
;
2011 Jan; 48(1): 25-30
Article
in English
| IMSEAR
| ID: sea-168741
ABSTRACT
Objective:
To develop a clinical strategy for detection of Congenital heart disease (CHD) in the newborn through a combination of clinical signs and pulse oximetry.Design:
Prospective longitudinal study.Setting:
Community level hospital in the city of Kochi, Kerala. Participants andinterventions:
All consecutive newborns between June 2006 and February 2009 were prospectively screened for CHD, 48 hours after birth. The on-site pediatrician performed clinical screening. A study nurse recorded pulse oximetry in a lower extremity; value of <94% was defined as abnormal. Echocardiography was performed on site by a trained research officer. A 6- week clinical follow-up evaluation was done for all. Main outcomemeasure:
Detection of CHD by echocardiography.Results:
Of 5487 babies screened, 425 (7.75%) had CHD. 17 (0.31%) had major CHD, two of whom (one ALCAPA and one large VSD) were missed during the initial evaluation. The rest were minor CHD (408 patients, 7.44%), most of which normalized by 6 weeks. On multivariate analysis, murmur, central cyanosis, abnormal precordial pulsations and abnormal pulse oximetry emerged as significant predictors of CHD. The sensitivity of clinical evaluation and pulse oximetry combined was 19% for all CHDs and 20% for major CHD; specificity was 88%.Conclusions:
In the community setting of a developing country, clinical evaluation and pulse oximetry after birth had a very low sensitivity for detection of CHD. Though an abnormal screening warrants prompt echocardiography, a 6-week clinical evaluation is recommended to ensure that major CHD is not missed.
Full text:
Available
Index:
IMSEAR (South-East Asia)
Type of study:
Diagnostic study
/
Observational study
/
Prognostic study
/
Screening study
Language:
English
Journal:
Indian Pediatr
Year:
2011
Type:
Article
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