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All newborns should undergo pulse oximetry screening for critical congenital heart disease

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Dr Swati Y Bhave, Adjunct Professor in Adolescent Medicine; Dr D Y Patil Medical College, & Dr D Y Patil Vidyapeeth, Pune; Sr. consultant, Adolescent Pediatrics & Head-In-charge of Adolescent Wellness Clinic, Jehangir Hospital Pune    27 February 2023

Critical congenital heart diseases (CHD) are lesions or defects that need surgical correction or other catheter-based procedures in the first year of life. As the term suggests, they are the most dangerous of the CHDs. Some critical CHDs are Tetralogy of Fallot, coarctation of the aorta, transposition of the great arteries, hypoplastic left heart syndrome, pulmonary atresia, tricuspid atresia and truncus arteriosus. Critical CHDs are often diagnosed soon after birth if the newborn is symptomatic. However, at times, the lesions may remain undiagnosed when the baby is discharged. A delayed diagnosis may have adverse morbidity and mortality outcomes. Pulse oximetry is recommended as a screening modality to detect critical CHDs in newborns, followed by an echocardiogram if indicated.

 

A recent study from the United States published in the journal Pediatric Cardiology has shown that those US states which had implemented mandatory pulse oximetry screening of newborns had fewer CHD-related emergency hospitalizations within the first three months after birth compared to when they did not have the mandatory screening or other states who had not implemented mandatory screening.1

 

Researchers from the United States and Japan conducted this study to examine if mandatory pulse oximetry screening influenced emergency hospitalizations among infants with critical congenital heart disease. They also examined the impact of race/ethnicity on this association. For this they utilized the inpatient databases from six states (Arizona, New Jersey, California, Kentucky, New York and Washington State) in the US from 2020 to 2014 to identify infants with critical congenital heart disease who were hospitalized at 3 days to 3 months of age as “emergency” or “urgent” or they were hospitalized via the emergency department. The outcome was the month-wise and state-wise number of emergency hospitalizations.

 

A total of 9147 emergency hospitalizations due to critical congenital heart disease were identified after examination of the databases. After the mandatory pulse oximetry screening was enforced, the critical CHD emergency hospitalizations reduced by 22% among non-Hispanic Whites. Among the non-Hispanic Blacks, the reduction in hospitalizations was 65% less than in non-Hispanic Whites suggesting “an attenuated association with decreased number of emergency hospitalizations among Black compared to White infants”. These findings suggest that along with physical examination, pulse oximetry screening should also be routinely carried out in all newborns.

 

Reference

 

  1. Sakai-Bizmark  R, et al. Pulse oximetry screening: association of state mandates with emergency hospitalizations. Pediatr Cardiol. 2023 Jan;44(1):67-74. doi: 10.1007/s00246-022-03027-3.

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