Critical Congenital Heart Disease Screening in Neonates in Sampran Hospital, Nakhon Pathom Province

Abstract

Objective: To initiate the screening program, treatment and referral program for critical congenital heart diseases in neonates who born at Sampran Hospital and study the incidence of congenital heart disease and efficacy of pulse oximetry screening in this population.

Methods: A prospective cohort study. We included all newborns from October 1, 2014 to August 31, 2016. Screening of oxygen saturation was conducted preductally (right hand) and postductally (any foot) with Radical Masimo® pulse oximeter on all newborns. Physical examination and pulse oximetry were performed on newborn after 24 hours of life. Then, the follow-up visits were scheduled at 1-2 months of life in all newborns. A screening result would be considered positive if any oxygen saturation measure was <90%, oxygen saturation 90-95% in both extremities on 3 measurements, each separated by 1 hour, or there was a >3% absolute difference in oxygen saturation between right hand and foot on 3 measurements, each separated by 1 hour. Echocardiogram was a confirm test in positive screened cases.

Results: 2,008 were eligible for screening by pulse oximetry screening and physical examination. True positive was found in 1 newborn (TOF with PDA with ASD) whereas false negative in 1 newborn (Complex heart disease, single ventricle). 1 newborn was questionable case. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 50%, 100%, 100%, 99.9%, 99.9% respectively, the incidence of CCHD was 1 per 1,000 live births.

Conclusions: The Sampran Screening program by pulse oximetry screening with physical examination in newborn were highly specific detection of CCHD and highly accuracy, positive predictive value and negative predictive value. This screening should be implemented in routine postnatal care for early detection CCHD. The sensitivity was 50% to detection of CCHD. Strategies to improve quality of the program should be developed.