Nomograms from 44647 Oxygen Saturations from Neonates Screened for Congenital Heart Disease in Northeast Brazil

Document Type : Original Article

Authors

1 Círculo do Coração de Pernambuco

2 Laboratório de Imunopatologia Keizo Asami

3 Círculo do Coração de Pernambuco

4 Laboratório de Imunopatologia Keizo Asami

Abstract

Background: Pulse oxygen saturation (POS) is a great strategy for screening critical congenital heart disease. Nomograms for pre-ductal and post-ductal POS have been described, but several factors like skin color, ambient temperature, altitude, presence of anemia, and others can modify them. Therefore, the analysis of nomograms in a developing country can be useful to optimize the screening for critical congenital heart disease (CCHD).

Objectives: to describe and analyze results of nomograms derived from pulse oximetry saturations from newborns screened for critical congenital heart disease in a state in Northeast Brazil.

Methods: Asymptomatic newborns with gestational age equal or above 34 weeks were screened for critical congenital heart disease through physical examination and pulse oximetry. We divided them according to gender, Apgar, the time when the pulse oximetry was performed and gestational age. The results of pre and post ductal saturations were compared among these groups with non-parametric tests. Twenty health centers were included.

Results : 44647 newborns screened for critical congenital heart disease were analyzed. The mean for preductal saturation was 97.37% and for post-ductal saturation was 97.44%. Statistical differences were encountered between pre and postducal saturations in almost all groups. Preterm neonates had lower saturations when compared with term neonates (p<0.001).

Conclusion: Nomograms for pre and post-ductal saturations, and differences between them, were described in 44647 neonates from Northeast Brazil. These nomograms can be utilized to optimize screening criteria for critical congenital heart disease.

Keywords


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1.Christianson AL, Howson CP, Modell B. March of dimes: global report on birth defects, the hidden toll of dying and disabled children. New York: White Plains; 2009.
 
2. Liu S, Liu J, Tang J, Ji J, Chen J, Liu C. Environmental risk factors for congenital heart disease in the Shandong Peninsula, China: a hospital-based case-control study. J Epidemiol. 2009; 19(3):122-30. [PubMed: 19398851].
https://doi.org/10.2188/jea.JE20080039
PMid:19398851 PMCid:PMC3924136
 
3. Anderson BR, Ciarleglio AJ, Hayes DA, Quaegebeur JM, Vincent JA, Bacha EA. Earlier arterial switch operation improves outcomes and reduces costs for neonates with transposition of the great arteries. J Am Coll Cardiol. 2014;63(5):481-7. [PubMed: 24184243] 4.
https://doi.org/10.1016/j.jacc.2013.08.1645
PMid:24184243
 
4. Hoffman JI. It is time for routine neonatal screening by pulse oximetry. Neonatology. 2011;99(1):1-9.. [PubMed: 20523077]. Paim Gomes de Freitas C et al. 10 Razavi Int J Med. 2018; 6(3):e55555.
https://doi.org/10.1159/000311216
PMid:20523077
 
5. Mahle WT, Newburger JW, Matherne GP, Smith FC, Hoke TR, Koppel R, et al. Role of pulse oximetry in examining newborns for congenital heart disease: a scientific statement from the American Heart Association and American Academy of Pediatrics. Circulation. 2009;120(5):447-58. [PubMed: 19581492].
https://doi.org/10.1161/CIRCULATIONAHA.109.192576
PMid:19581492
 
6. Thangaratinam S, Brown K, Zamora J, Khan KS, Ewer AK. Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: a systematic review and meta-analysis. Lancet. 2012;379(9835):2459-64. [PubMed: 22554860].
https://doi.org/10.1016/S0140-6736(12)60107-X
PMid:22554860
 
7. Jegatheesan P, Song D, Angell C, Devarajan K, Govindaswami B. Oxygen Saturation Nomogram in Newborns Screened for Critical Congenital Heart Disease. Pediatrics. 2013;131(6):e1803-10. [PubMed: 23690522].
https://doi.org/10.1542/peds.2012-3320
PMid:23690522
 
8. Fouzas S, Priftis KN, Anthracopoulos MB. Pulse oximetry in pediatric practice. Pediatrics. 2011;128(4):740-52. [PubMed: 21930554].
https://doi.org/10.1542/peds.2011-0271
PMid:21930554
 
9. de-Wahl Granelli A, Wennergren M, Sandberg K, Mellander M, Bejlum C, Inganas L, et al. Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: a Swedish prospective screening study in 39 821 newborns. BMJ. 2009;338:a3037. [PubMed: 19131383].
https://doi.org/10.1136/bmj.a3037
PMid:19131383 PMCid:PMC2627280
 
10. Ewer AK, Middleton LJ, Furmston AT, Bhoyar A, Daniels JP, Thangaratinam S, et al. Pulse oximetry screening for congenital heart defects in newborn infants (PulseOx): a test accuracy study. Lancet. 2011;378(9793):785-94. [PubMed: 21820732].
https://doi.org/10.1016/S0140-6736(11)60753-8
PMid:21820732
 
11. Garg LF, Van Naarden Braun K, Knapp MM, Anderson TM, Koppel RI, Hirsch D, et al. Results from the New Jersey statewide critical congenital heart defects screening program. Pediatrics. 2013;132(2):e314-23 [PubMed: 23858425].
https://doi.org/10.1542/peds.2013-0269
PMid:23858425 PMCid:PMC4471476
 
12. Koppel RI, Druschel CM, Carter T, Goldberg BE, Mehta PN, Talwar R, et al. Effectiveness of pulse oximetry screening for congenital heart disease in asymptomatic newborns. Pediatrics. 2003;111(3):451-5. [PubMed: 12612220].
https://doi.org/10.1542/peds.111.3.451
PMid:12612220
 
13. Sendelbach DM, Jackson GL, Lai SS, Fixler DE, Stehel EK, Engle WD. Pulse oximetry screening at 4 hours of age to detect critical congenital heart defects. Pediatrics. 2008;122(4):e815- 20. [PubMed: 18762486].
https://doi.org/10.1542/peds.2008-0781
PMid:18762486
 
14. Riede FT, Wörner C, Dähnert I, Möckel A, Kostelka M, Schneider P. Effectiveness of neonatal pulse oximetry screening for detection of critical congenital heart disease in daily clinical routine--results from a prospective multicenter study. Eur J Pediatr. 2010;169(8):975-81. [PubMed: 20195633].
https://doi.org/10.1007/s00431-010-1160-4
PMid:20195633 PMCid:PMC2890074
 
15. Meberg A, Brügmann-Pieper S, Due R, Eskedal L, Fagerli I, Farstad T, et al. First day of life pulse oximetry screening to detect congenital heart defects. J Pediatr. 2008;152(6):761-5. [PubMed: 18492511].
https://doi.org/10.1016/j.jpeds.2007.12.043
PMid:18492511
 
16. Moser LR, Diogenes TC, Souza VO, Oliveira AR, Mourato FA, Mattos SD. Novo modelo de teletriagem das cardiopatias congênitas. J Bras Tele. 2014;3(1):229-31.
https://doi.org/10.12957/jbrastele.2014.10236
 
17. Moser L, Diogenes T, Mourato FA, Mattos S. Learning echocardiography and changing realities through telemedicine. Med Educ. 2014;48(11):1125-6. [PubMed: 25307664].
https://doi.org/10.1111/medu.12561
PMid:25307664
 
18. Dimich I, Singh PP, Adell A, Hendler M, Sonnenklar N, Jhaveri M. Evaluation of oxygen saturation monitoring by pulse oximetry in neonates in the delivery system. Can J Anaesth. 1991;38(8):985- 8. [PubMed: 1752021].
https://doi.org/10.1007/BF03008616
PMid:1752021
 
19. Hoke TR, Donohue PK, Bawa PK, Mitchell RD, Pathak A, Rowe PC, et al. Oxygen saturation as a screening test for critical congenital heart disease: a preliminary study. Pediatr Cardiol. 2002; 23(4):403-9. [PubMed: 12170356].
https://doi.org/10.1007/s00246-002-1482-8
PMid:12170356
 
20. Kochilas LK, Menk JS, Saarinen A, Gaviglio A, Lohr JL. A comparison of retesting rates using alternative testing algorithms in the pilot implementation of critical congenital heart disease screening in Minnesota. Pediatr Cardiol. 2014;36(3):550-4. [PubMed: 25304248].
https://doi.org/10.1007/s00246-014-1048-6
PMid:25304248
 
21. Rüegger C, Bucher HU, Mieth RA. Pulse oximetry in the newborn: is the left hand pre- or post-ductal? BMC Pediatr. 2010;10:35. [PubMed: 20492689].
https://doi.org/10.1186/1471-2431-10-35
PMid:20492689 PMCid:PMC2879243
 
22. Mariani G, Dik PB, Ezquer A, Aguirre A, Esteban ML, Perez C, et al. Pre-ductal and post-ductal O2 saturation in healthy term neonates after birth. J Pediatr. 2007;150(4):418-21. [PubMed: 17382123].
https://doi.org/10.1016/j.jpeds.2006.12.015
PMid:17382123
 
23. Kamlin CO, O'Donnell CP, Davis PG, Morley CJ. Oxygen saturation in healthy infants immediately after birth. J Pediatr. 2006;148(5):585-9. [PubMed: 16737865].
https://doi.org/10.1016/j.jpeds.2005.12.050
PMid:16737865
 
24. Iliodromiti S, Mackay DF, Smith GC, Pell JP, Nelson SM. Apgar score and the risk of cause-specific infant mortality: a population-based cohort study. Lancet. 2014;384(9956): 1749-55 [PubMed: 25236409].
https://doi.org/10.1016/S0140-6736(14)61135-1
PMid:25236409