Evaluation of critical congenital heart defects screening using pulse oximetry in the neonatal intensive care unit.

OBJECTIVE: To evaluate the implementation of early screening for critical congenital heart defects (CCHDs) in the neonatal intensive care unit (NICU) and potential exclusion of sub-populations from universal screening. STUDY DESIGN: Prospective evaluation of CCHD screening at multiple time intervals was conducted in 21 NICUs across five states (n=4556 infants). RESULTS: Of the 4120 infants with complete screens, 92% did not have prenatal CHD diagnosis or echocardiography before screening, 72% were not receiving oxygen at 24 to 48 h and 56% were born ⩾2500 g. Thirty-seven infants failed screening (0.9%); none with an unsuspected CCHD. False positive rates were low for infants not receiving oxygen (0.5%) and those screened after weaning (0.6%), yet higher among infants born at <28 weeks (3.8%). Unnecessary echocardiograms were minimal (0.2%). CONCLUSION: Given the majority of NICU infants were ⩾2500 g, not on oxygen and not preidentified for CCHD, systematic screening at 24 to 48 h may be of benefit for early detection of CCHD with minimal burden.

Topographic mapping of brain potentials in the newborn infant: the establishment of normal values and utility in assessing infants with neurological injury.

AIM: To demonstrate that quantitative EEG (qEEG) can be used as a non-invasive measure of brain injury by establishing normative data in term infants and contrasting it with other modalities of brain imaging. DESIGN: qEEG during quiet sleep was performed on 13 healthy full-term infants comprising a normal group and on 10 infants with neurological abnormalities identified on brain imaging studies (abnormal group) at 36-47 wk postconceptional age. Quantitative analysis was performed and topographic maps were produced for each patient. The EEG data from the normal group, after spectral analysis, yielded power data in the delta, theta, alpha, and beta frequency bands and coherence information, which then formed the normative database. qEEG from the infants in the abnormal group was then compared to this normative data. RESULTS: The normal group's mean absolute power in the delta, theta, alpha, and beta bands for all EEG leads combined were 278.48+/-83.83, 31.71+/-10.12, 29.20+/-2.04, and 35.76+/-11.35 uv2, respectively. The median frequency was 1.49+/-0.07, 5.45+/-3.46, 9.74+/-5.11, and 18.01+/-3.38 Hz, respectively. The qEEG was abnormal in all 10 study infants, while abnormalities were noted in the clinical EEG in 4 of 10, in the neuroultrasound in 5 of 10, in the CT in one of 6, and in the MRI in 2 of 2 tested. CONCLUSIONS: qEEG appears to be a useful non-invasive method for measuring brain injury as it correlates well with other modalities of brain imaging and, if corroborated by further study, may, in fact, be more sensitive in determining abnormalities in brain function.

The incidence of gastroesophageal reflux in preterm infants.

We observed an increased incidence of gastroesophageal reflux (GER) in a group of preterm infants. Seventy-five infants (birth weight 1117 +/- 242 gm, gestational age 30 +/- 3 weeks) were tested within 1 week before hospital discharge (37 to 38 weeks postconceptional age). All of the infants had a two-channel pneumocardiogram and a 1-hour esophageal pH study (Tuttle test). Home monitors were used for all infants after hospital discharge and their use was maintained until standard discontinuation criteria were achieved. The Tuttle test was abnormal in 47 (63%) of the infants. Of the 47 infants with GER, 22 (47%) had evidence of obstructive apnea during the periods of reflux and 32 (68%) had an abnormal PCG result. Thirty-eight (81%) of the infants with GER had episodes of either obstructive or central apnea. The diagnosis of GER is important in premature infants because of the high association with recurrent or obstructive apnea.