Updated Strategies for Pulse Oximetry Screening for Critical Congenital Heart Disease
Updated Strategies for Pulse Oximetry Screening for Critical Congenital Heart Disease
复制标题
DOI：
10.1542/peds.2019-1650
复制
发表时间：
2020-07-01
期刊：
影响因子：
8
通讯作者：
Oster, Matthew E.
中科院分区：
文献类型：
--
作者：
Martin, Gerard R.;Ewer, Andrew K.;Oster, Matthew E.
在加入美国推荐的统一筛查小组七年后，在美国，使用脉搏血氧仪对新生儿进行危重先天性心脏病(CCHD)筛查成为强制性规定。尽管CCHD新生儿筛查降低了发病率和死亡率，但仍有重要的改善机会。一个专家小组于2018年9月召开了为期一天的会议，成员包括专题专家和利益攸关方组织的代表。介绍CCHD结果、筛查方法的变化以及数据和质量改进有助于确定改进机会。专家小组的结论是，有足够的证据建议修改目前的美国儿科学会的算法，方法是：(1)要求上肢和下肢的血氧饱和度都至少达到95%才能通过，(2)对于最初既不通过也不失败的情况，只要求重复进行一次筛查，而不是两次。该小组强调，通过进一步明确筛查目标和报告结果的标准(假阴性和假阳性病例)，改进公共卫生报告的重要性。该小组还强调，需要确保为CCHD新生儿筛查以及教育和全球实施机会提供足够的公共卫生资金。使用脉搏血氧仪对新生儿进行CCHD筛查已显著改善了儿童的健康状况。然而，要了解和提高筛查的有效性和效率，还需要进一步的重要工作。
Seven years after its addition to the US Recommended Uniform Screening Panel, newborn screening for critical congenital heart disease (CCHD) using pulse oximetry became mandatory in the United States. Although CCHD newborn screening reduces morbidity and mortality, there remain important opportunities to improve. An expert panel convened for a 1-day meeting in September 2018, including subject matter experts and representatives from stakeholder organizations. Presentations on CCHD outcomes, variations in approach to screening, and data and quality improvement helped identify improvement opportunities. The expert panel concluded that sufficient evidence exists to recommend modifying the current American Academy of Pediatrics algorithm by (1) requiring an oxygen saturation of at least 95% in both (formerly either) the upper and lower extremities to pass and (2) requiring only 1 repeat screen instead of 2 for cases that neither pass nor fail initially. The panel underscored the importance of improving public health reporting by further specifying the targets of screening and criteria for reporting outcomes (false-negative and false-positive cases). The panel also highlighted the need to ensure sufficient public health funding for CCHD newborn screening and opportunities for education and global implementation. Newborn screening for CCHD using pulse oximetry has led to significant improvements in child health outcomes. However, further important work is required to understand and improve the effectiveness and efficiency of screening.