Late detection of critical congenital heart disease among US infants: estimation of the potential impact of proposed universal screening using pulse oximetry.
Late detection of critical congenital heart disease among US infants: estimation of the potential impact of proposed universal screening using pulse oximetry.
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DOI：
10.1001/jamapediatrics.2013.4779
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发表时间：
2014-04
期刊：
影响因子：
26.1
通讯作者：
Gilboa, Suzanne M.
中科院分区：
文献类型：
--
作者：
Peterson, Cora;Ailes, Elizabeth;Riehle-Colarusso, Tiffany;Oster, Matthew E.;Olney, Richard S.;Cassell, Cynthia H.;Fixler, David E.;Carmichael, Suzan L.;Shaw, Gary M.;Gilboa, Suzanne M.
2011 年，美国新生儿推荐统一筛查小组中增加了危重先天性心脏病 (CCHD)。许多州最近已采用或正在考虑在产医院通过脉搏血氧仪进行普遍 CCHD 筛查的要求。先前有限的研究直接适用于通过筛查可以识别出多少患有 CCHD 的美国婴儿的问题。根据现有的临床实践估计美国婴儿晚期检测出 CCHD（出生后 3 天以上）的比例，并调查与晚期检测相关的因素。描述性和多变量分析。数据来自美国一项基于人口的多地点出生缺陷研究，即国家出生缺陷预防研究 (NBDPS)。我们纳入了所有预计分娩日期为 1998 年 1 月 1 日至 2007 年 12 月 31 日的活产婴儿，以及通过脉搏血氧测定法筛查可能检测到的非综合征性、临床验证的 CCHD 状况。主要结果指标是通过超声心动图或尸检晚期发现 CCHD 的婴儿比例，假设出生医院的普遍筛查可能会减少此类晚期诊断的数量。次要结果指标包括选定的人口统计学和临床因素之间关联的患病率以及 CCHD 的晚期检测。在 3746 名患有非综合征性 CCHD 的活产婴儿中，有 1106 名（29.5% [95%CI, 28.1%–31.0%]）发现较晚，其中 6 名（0.2%）（0.1%–0.4%）在出生后 3 天以上首次在尸检中得到诊断。晚期检测因 CCHD 类型而异，从 120 名婴儿中的 9 名（7.5%[95%CI，3.5%–13.8%]）患有肺动脉闭锁，到 801 名婴儿中的 497 名（62.0%[58.7%–65.4%]）患有主动脉缩窄。在多变量分析中，晚期检测因 CCHD 类型和研究地点而异，存在心外缺陷的婴儿晚期检测 CCHD 的可能性显着降低（调整后患病率，0.58 [95% CI，0.49-0.69]）。我们估计，NBDPS 中 29.5% 的患有非综合征性 CCHD 的活产婴儿在出生后 3 天以上得到诊断，因此可能受益于产科医院的常规 CCHD 筛查。通过筛查检测出 CCHD 的婴儿数量可能因多种因素而异，包括 CCHD 类型。需要更多基于人群的实践筛查研究。
Critical congenital heart disease (CCHD) was added to the Recommended Uniform Screening Panel for Newborns in the United States in 2011. Many states have recently adopted or are considering requirements for universal CCHD screening through pulse oximetry in birth hospitals. Limited previous research is directly applicable to the question of how many US infants with CCHD might be identified through screening. To estimate the proportion of US infants with late detection of CCHD (>3 days after birth) based on existing clinical practice and to investigate factors associated with late detection. Descriptive and multivariable analysis. Data were obtained from a multisite population-based study of birth defects in the United States, the National Birth Defects Prevention Study (NBDPS). We included all live-born infants with estimated dates of delivery from January 1, 1998, through December 31, 2007, and nonsyndromic, clinically verified CCHD conditions potentially detectable through screening via pulse oximetry. The main outcome measure was the proportion of infants with late detection of CCHD through echocardiography or at autopsy under the assumption that universal screening at birth hospitals might reduce the number of such late diagnoses. Secondary outcome measures included prevalence ratios for associations between selected demographic and clinical factors and late detection of CCHD. Of 3746 live-born infants with nonsyndromic CCHD, late detection occurred in 1106 (29.5% [95%CI, 28.1%–31.0%]), including 6 (0.2%) (0.1% –0.4%) first receiving a diagnosis at autopsy more than 3 days after birth. Late detection varied by CCHD type from 9 of 120 infants (7.5%[95%CI, 3.5%–13.8%]) with pulmonary atresia to 497 of 801 (62.0% [58.7%–65.4%]) with coarctation of the aorta. In multivariable analysis, late detection varied significantly by CCHD type and study site, and infants with extracardiac defects were significantly less likely to have late detection of CCHD (adjusted prevalence ratio, 0.58 [95% CI, 0.49–0.69]). We estimate that 29.5%of live-born infants with nonsyndromic CCHD in the NBDPS received a diagnosis more than 3 days after birth and therefore might have benefited from routine CCHD screening at birth hospitals. The number of infants in whom CCHD was detected through screening likely varies by several factors, including CCHD type. Additional population-based studies of screening in practice are needed.
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105.7
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de-Wahl Granelli, Anne;Wennergren, Margareta;Sandberg, Kenneth;Mellander, Mats;Bejlum, Carina;Inganas, Leif;Eriksson, Monica;Segerdahl, Niklas;Agren, Annelie;Ekman-Joelsson, Britt-Marie;Sunnegardh, Jan;Verdicchio, Mario;Ostman-Smith, Ingegerd
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Ostman-Smith, Ingegerd
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Hoke, TR;Donohue, PK;Byrne, BJ
通讯作者：
Byrne, BJ
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3.8
作者：
Meberg, Alf;Andreassen, Andreas;Skalevik, Jan Einar
通讯作者：
Skalevik, Jan Einar
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作者：
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