ABSTRACT
BACKGROUND: Neonatal pulse oximetry screening (POS) algorithms for critical congenital heart disease (CCHD) have contributed towards decreasing neonatal mortality but cannot be applied at high altitudes. New POS algorithms at high altitudes are needed. METHODS: This observational, prospective study included newborns born at different altitudes from 0 to 4380 meters above the sea level in Peru. Healthy newborns underwent neonatal preductal and postductal oximetry, echocardiography and telephonic follow-up up to 12 months of age. Newborns with CCHD underwent preductal and postductal oximetry at the time of telemedicine evaluation while located at the high-altitude hospital where they were born, and their diagnoses were confirmed with echocardiography locally or after arriving to the referral center. Two new algorithms were designed using clinically accepted neonatal oximetry cutoffs or the 5th and 10th percentiles for preductal and postductal oximetry values. RESULTS: A total of 502 healthy newborns and 15 newborns with CCHD were enrolled. Echocardiography and telephonic follow-up were completed in 227 (45%) and 330 healthy newborns (65%), respectively. The algorithm based on clinically accepted cutoffs had a sensitivity of 92%, specificity of 73% and false positive rate of 27% The algorithm based on the 5th and 10th percentiles had a sensitivity of 80%, specificity of 88% and false positive rate of 12%. CONCLUSIONS: Two algorithms that detect CCHD at different altitudes had adequate performance but high false positive rates.
Subject(s)
Altitude , Heart Defects, Congenital , Humans , Infant, Newborn , Prospective Studies , Heart Defects, Congenital/diagnostic imaging , Oximetry , Neonatal Screening , AlgorithmsABSTRACT
El desarrollo y la utilización cada vez mayor número de procedimientos mínimamente invasivos ha supuesto que, con más frecuencia, fragmentos de los materiales utilizados se rompan y permanezcan retenidos en el organismo, tanto en la zona donde se está interviniendo como a distancia (por ®embolización¼ de dicho fragmento) . Presentamos a propósito, el caso de un Recién Nacido, prematuro, de 17 días de nacido, con peso de 2,178 g, que habiéndosele colocado un catéter central de inserción periférica (PICC), se fracturó durante su retiro y se desplazó hasta ubicarse en la porción distal en la rama izquierda de la arteria pulmonar. El catéter se extrajo por vía femoral mediante un cateterismo cardíaco intervencionista, con lo que se evitó cirugía a corazón abierto y se demostró la efectividad de dicho procedimiento ante este tipo de complicación...
