Pulse oximetry screening as a complementary strategy to detect critical congenital heart defects
Pulse oximetry screening as a complementary strategy to detect critical congenital heart defects
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DOI：
10.1111/j.1651-2227.2008.01199.x
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发表时间：
2009-04-01
期刊：
影响因子：
3.8
通讯作者：
Skalevik, Jan Einar
中科院分区：
文献类型：
--
作者：
Meberg, Alf;Andreassen, Andreas;Skalevik, Jan Einar
目的：比较采用和不采用生命第一天脉搏血氧仪筛查检测危重先天性心脏缺陷（CCHDs）的策略。研究设计：以人口为基础的研究，包括2005年和2006年挪威所有活产婴儿（n = 116057）。对转入托儿所后表面健康的新生儿进行导管后（足）动脉血氧饱和度（SpO(2)）测定，以SpO(2) < 95%为分界点。在进行脉搏血氧仪筛查的医院中，57 959例活产婴儿中，有5 008例（86%）得到了筛查。结果：共确诊136例CCHDs(1.2 / 1000)，其中38例（28%）为产前诊断。在出生后检测到的CCHDs中，有44/50（88%）在提供脉搏血氧仪筛查的人群中（25人接受脉搏血氧仪筛查）在出院前被检测到，而在未接受筛查的人群中，这一比例为37/48 (77%)（p = 0.15）。出院前住院诊断冠心病的中位时间分别为出生后6小时和16小时（p < 0.0001）。在筛查人群中，6/50（12%）的CCHDs在出院后因症状而被遗漏和识别。6例漏诊患者中2例脉搏血氧仪筛查失败，但被忽视（出院前未进行超声心动图检查）。如果这些病例被发现，4/50（8%）将被遗漏，而未筛查人群的11/48（23%）将被遗漏（p = 0.05）。在遗漏的病例中，14/17（82%）有左侧阻塞性病变。结论：生命第一天脉搏血氧仪筛查可以早期发现CCHDs，减少出院后的漏诊和诊断。
Objective: To compare strategies with and without first-day of life pulse oximetry screening to detect critical congenital heart defects (CCHDs).Study design: Population based study including all live born infants in Norway in 2005 and 2006 (n = 116 057). Postductal (foot) arterial oxygen saturation (SpO(2)) was measured in apparently healthy newborns after transferral to the nursery, with SpO(2) < 95% as cut-off point. Out of 57 959 live births in the hospitals performing pulse oximetry screening, 50 008 (86%) were screened.Results: A total of 136 CCHDs (1.2 per 1000) were diagnosed, 38 (28%) of these prenatally. Of the CCHDs detected after birth, 44/50 (88%) were detected before discharge in the population offered pulse oximetry screening (25 by pulse oximetry), compared to 37/48 (77%) in the non-screened population (p = 0.15). Median times for diagnosing CCHDs in-hospital before discharge were 6 and 16 h after birth respectively (p < 0.0001). In the screened population 6/50 (12%) CCHDs were missed and recognized after discharge because of symptoms. Two of the six missed cases failed the pulse oximetry screening, but were overlooked (echocardiography not performed before discharge). If these cases had been recognized, 4/50 (8%) would have been missed compared to 11/48 (23%) in the non-screened population (p = 0.05). Of the cases missed, 14/17 (82%) had left-sided obstructive lesions.Conclusion: First-day of life pulse oximetry screening provides early in-hospital detection of CCHDs and may reduce the number missed and diagnosed after discharge.