چاپ صفحه |  صفحه نخست سامانه |  نویسندگان |  اطلاعات تفضیلی |  دانلود مقاله | دانشگاه علوم پزشکی تبریز |
| نویسنده | نفر چندم مقاله |
|---|---|
| اکبر مولائی | اول |
| محمود صمدی | دوم |
| احمد جامعی خسروشاهی | سوم |
| شمسی غفاری باویل علیا | چهارم |
| عنوان | متن |
|---|---|
| خلاصه مقاله | We tried to discuss the impact of early diagnosis on outcome of critical congenital heart diseases (CCHDs), current options, and their limitations in timely diagnosis, utility of pulse oximetry screening (POS), current recommendations for screening and challenges in resource constrained countries and to suggest further avenues to cover existing gaps. Evidence acquisition process was performed on the PubMed database and Google scholar for every available article in peer reviewed journals. Prevalence of congenital heart disease (CHD) at birth is estimated to be 8/1,000 live births. About 25% of CHDs are life threatening CCHDs. The current guidelines for POS recommend that all neonates in well newborn nurseries should preferably be screened after 24 h of life. A screen is taken to be positive, “out of range” or a fail if oxygen saturation is (i) <90%, (ii) <95% in right hand and one foot after three measurements (each taken 1 h apart), or iii) difference of >3% in preductal and postductal saturations after three measurements (each separated by 1 h). POS has a specificity of 99.9% for the detection of CCHDs. It has a false positive rate of 0.05% for the same. It is estimated that POS may be able to detect nearly 50%–70% of infants born with undiagnosed CCHDs. Opportunity and feasibility for POS is higher in the sick nursery even in the resource constrained setting where most of the well nurseries may not have availability of pulse oximeter, echocardiography and neonatal cardiothoracic surgery services. CCHDs can be detected early using POS which is a convenient, noninvasive and cost effective method. All necessary criteria required for inclusion to universal newborn screening panel are fulfilled by POS. The current POS guidelines are for asymptomatic newborns in well newborn nurseries. Evidence based guidelines are still lacking for screening infants in neonatal intensive care settings. We also propose here a protocol for POS in the neonatal Intensive Care Unit. Pulse oximetry screening in sick nursery/neonatal Intensive Care Unit Although pulse oximetry is available in the sick nursery even in resource constrained settings, studies on POS in the NICU are scanty and its implementation including observation of pre‑.and post‑ductal saturations is poor. A pilot study including 950 neonates was conducted in a tertiary referral NICU in India and evaluated POS for detection of congenital cyanotic heart disease. Pulse oximetry was considered abnormal if the oxygen saturation at room air or on oxygen measured <90% or a >3% difference between right hand and foot was present. 3 observations each at an interval of at least 1 h were taken in all neonates with abnormal pulse oximetry. Detection of CCHD by POS had sensitivity, specificity, positive predictive value, negative predictive value of 95.2%, 52.4%, 9.5%, 99.5% respectively. It was also found to have a positive likelihood ratio, negative likelihood ratio and odds ratio (95% CI) of 2.0, 0.1 and 22 (5.3–91.4) respectively. Detection of CCHD and persistent pulmonary hypertension by POS had sensitivity and negative predictive value of 97.5% (39/40)and 99.5% (209/210) respectively. As POS was additionally positive in cases of respiratory diseases, acyanotic heart diseases with congestive heart failure, shock and persistent pulmonary hypertension, it had a low specificity. Table 1: Proposed criteria for positive pulse oximetry screening in neonatal Intensive Care Unit/sick nursery: Oxygen saturation at room air or on oxygen<90%; or/and >3% difference between right hand and foot and Abnormal pulse oximetry continues to be present till the last reading (3 observations, each at an interval of at least 1 h) Conclusions In conclusion, POS for early identification of CCHD fulfills the required necessary criteria for inclusion to universal newborn screening panel. It is a simple, noninvasive and cost effective test. Significant decrease in morbidity and mortality in infants with CCHD can be observed by a wider acceptance and adoption of POS. This reduction in morbidity and mortality is likely to be more pronounced in infants who are born without a prenatal diagnosis especially those in low resource settings. In resource limited countries, a cut off of 90% oxygen saturation would lead to reduced referrals for echocardiography and needs further evaluation. Figure 2: The proposed pulse oximetry monitoring protocol based on results from the right hand and either foot in neonatal Intensive Care Unit. Neonates pulse oximetry screening positive on room air or after weaning from oxygen therapy, those with significant difference in pre and postductal saturations on oxygen and those requiring unexplained prolonged oxygen therapy should be subjected to echocardiography. RH: Right hand, F: Foot. |
| کلمات کلیدی | Pulse Oximetry Screening ، Neonates ،Heart Disease |
| نام فایل | تاریخ درج فایل | اندازه فایل | دانلود |
|---|---|---|---|
| 98-7.jpg | 1398/09/20 | 132677 | دانلود |
| 98-8.jpg | 1398/09/20 | 147597 | دانلود |
| 98-9.jpg | 1398/09/20 | 114388 | دانلود |
| 98-10.jpg | 1398/09/20 | 89530 | دانلود |
| govahi.pdf | 1398/09/23 | 48856 | دانلود |
