ABSTRACT
OBJECTIVE: To evaluate the predictive abilities of pulse oximetry screening (POS) for critical congenital heart disease (CRIT.CHD) at two different hospital settings in Thailand. STUDY DESIGN: The study was conducted in healthy newborns at Ramathibodi Hospital (RH), a university hospital and Maharat Nakhon Ratchasima Hospital (MH), a regional hospital. Positive POS was defined as oxygen saturation (SpO2) <95% or difference between pre- and postductal SpO2 >3%. RESULTS: Of 11 407 live births, 10 603 (92.9%) newborns were enrolled with a follow-up rate at 1 month of 78.3%. Incidence of CRIT.CHD (per 1000 live births) at RH and MH were 5.7 and 2.7, respectively. POS could detect three newborns who would have had a missed diagnosis. Sensitivity of POS for CRIT.CHD at RH was 82.3% vs 100% at MH. Overall specificity was 99.9% and false-positive rate was 0.009%. Combination of POS and physical examination (PE) enhanced detection ability to 100% at both hospitals. CONCLUSION: POS combined with PE improved detection of CRIT.CHD. Routine POS is useful in personnel-limited settings.
Subject(s)
Heart Defects, Congenital/diagnosis , Neonatal Screening/methods , Oximetry , Oxygen/blood , Female , Heart Defects, Congenital/blood , Hospitals , Humans , Infant, Newborn , Male , Physical Examination , Predictive Value of Tests , Prospective Studies , ThailandABSTRACT
BACKGROUND: A recent multinational clinical trial in preterm infants has demonstrated pulmonary and neurodevelopmental benefits from caffeine therapy. Indications for caffeine use in that study were predominantly for treatment of apnea and facilitation of extubation rather than prophylaxis. There are no recent studies that describe current practice of neonatologists and regional differences in regards to indications for starting, monitoring and discontinuing methylxanthine therapy in premature infants. OBJECTIVE: To characterize the spectrum of current practice and demonstrate the extent to which methylxanthine therapy varies by location. METHODS: A cross-sectional survey of all neonatologists in Thailand, Lebanon, Australia, and a representative sample in the USA regarding management of apnea of prematurity. RESULTS: The response rate was 50% (342/681). The methylxanthine of choice varied greatly across study locations. Prophylactic methylxanthine use is common (62%) among neonatologists in all four study locations. Significant variation exists in almost all aspects of apnea pharmacotherapy practice among neonatologists in different international locations. CONCLUSIONS: Prophylactic use of methylxanthine therapy for apnea of prematurity is widespread. We speculate that this expanded use is possibly attributed to the beneficial effects of caffeine therapy in the Caffeine for Apnea of Prematurity (CAP) Trial.
