Pulse Oximetry and Auscultation for Congenital Heart Disease Detection
Pulse Oximetry and Auscultation for Congenital Heart Disease Detection
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DOI：
10.1542/peds.2017-1154
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发表时间：
2017-10-01
期刊：
影响因子：
8
通讯作者：
Huang, Guo-ying
中科院分区：
文献类型：
--
作者：
Hu, Xiao-jing;Ma, Xiao-jing;Huang, Guo-ying
目的：脉搏血氧饱和度（POX）已被证实为危重先天性心脏病（CCHD）的特异性筛查方式，具有中等敏感性。然而，POX不能检测出大多数严重和关键的心脏病变（主要先天性心脏病[CHD]）而不伴有低氧血症。在这项研究中，我们调查的准确性和可行性，增加心脏听诊POX作为无症状的重大CHD.METHODS筛选方法：多中心前瞻性观察筛选研究在上海15家医院之间进行2012年7月1日至2014年12月31日。POX或心脏听诊异常的新生儿被定义为筛查阳性。所有筛查阳性新生儿均接受进一步超声心动图检查。假阴性结果通过临床随访、家长反馈和电话复查确定。结果：15家医院均完成了冠心病筛查，筛查率为94.0%~ 99.8%。总共筛查了167190名连续无症状新生儿，其中203名患有重大CHD（44名危重和159名严重）。POX联合心脏听诊诊断CCHD的敏感性为95.5%（95%可信区间84.9%~ 98.7%），诊断主要CHD的敏感性为92.1%（95%可信区间87.7%~ 95.1%）。假阳性率为1.2%，检测CCHD和1.1%，检测主要CHD。结论：在我们目前的研究中，我们表明，使用POX加上心脏听诊显着提高了主要CHD的检出率在新生儿早期阶段，具有较高的灵敏度和合理的假阳性率。为新生儿CHD的筛查提供了有力的依据和可靠的方法。
OBJECTIVES: Pulse oximetry (POX) has been confirmed as a specific screening modality for critical congenital heart disease (CCHD), with moderate sensitivity. However, POX is not able to detect most serious and critical cardiac lesions (major congenital heart disease [CHD]) without hypoxemia. In this study, we investigated the accuracy and feasibility of the addition of cardiac auscultation to POX as a screening method for asymptomatic major CHD.METHODS: A multicenter prospective observational screening study was conducted at 15 hospitals in Shanghai between July 1, 2012, and December 31, 2014. Newborns with either an abnormal POX or cardiac auscultation were defined as screen positive. All screenpositive newborns underwent further echocardiography. False-negative results were identified by clinical follow-up, parents' feedback, and telephone review. We assessed the accuracy of POX plus cardiac auscultation for the detection of major CHD.RESULTS: CHD screening was completed in all 15 hospitals, with a screening rate of 94.0% to 99.8%. In total, 167 190 consecutive asymptomatic newborn infants were screened, of which 203 had major CHD (44 critical and 159 serious). The sensitivity of POX plus cardiac auscultation was 95.5% (95% confidence interval 84.9%-98.7%) for CCHD and 92.1% (95% confidence interval 87.7%-95.1%) for major CHD. The false-positive rate was 1.2% for detecting CCHD and 1.1% for detecting major CHD.CONCLUSIONS: In our current study, we show that using POX plus cardiac auscultation significantly improved the detection rate of major CHD in the early neonatal stage, with high sensitivity and a reasonable false-positive rate. It provides strong evidence and a reliable method for neonatal CHD screening.