An 8-day-old infant with poor perfusion and diaphoresis

Early diagnosis and screening of congenital cardiac anomalies

Considerable numbers of congenital cardiac anomalies are missed at the time of delivery. Study reports show that congenital cardiac anomalies are the second most common birth defect in many countries. Despite this fact, our previous study showed that the prevalence of congenital cardiac anomalies is the fifth most common one, indicating that many of these defects might not be properly diagnosed at the time of delivery and birth. The aim of this study was to estimate the missing frequency of congenital cardiac anomalies at the time of delivery and birth. The population of the study was 185,650 births in the Northwest region of Iran covered by the Tabriz Registry of Congenital Anomalies. A total of 451 children with congenital cardiac anomalies were studied in the region from 2000 to 2009. The expected prevalence of congenital cardiac anomalies at birth was estimated to be 24.2 per 10,000 births while a prevalence of 9.2 per 10,000 births was observed at the same time and place. This indicated that 59.1% of children with congenital cardiac anomalies were not identified at birth (p-value less than 0.05). This proportion increased by 13% over the study period from 2000 to 2009 (p-value greater than 0.1). Our findings indicated that a remarkable frequency of congenital cardiac anomalies was not diagnosed at birth because there was no paediatric cardiologist available at the time of birth in the gynaecology and obstetrics wards.

Screening newborns for congenital heart disease with pulse oximetry: survey of pediatric cardiologists

BACKGROUND

Controversies exist regarding the use of pulse oximetry for routine screening of newborns. This study aimed to evaluate current practices and opinions of pediatric cardiologists in relation to newborn screening for congenital heart disease (CHD) using pulse oximetry.

METHODS

Email invitations were sent to 1,045 pediatric cardiologists in North America. The survey was Internet based and included multiple-choice questions. Two repeat email reminders were sent after the initial invitation.

RESULTS

A total of 363 responses (35%) were returned. In terms of experience, 40% of the respondents had more than 20 years, 32% had 10 to 20 years, 21% had 5 to 10 years, and 6% had less than 5 years of experience. More than 90% agreed that an early diagnosis of CHD for newborns prevents morbidity and mortality. In terms of practice, 96% reported that all newborns are examined by a clinician before discharge, 29% reported that newborns get a pulse oximetry reading, and 1.4% (n = 5) reported the use of electrocardiogram. Only 58% of respondents thought that current practice is adequate for detecting significant CHD. With regard to their experience with pulse oximetry, 26% reported "too many false-positives," 21% described it as "prone to noise and artifact," and 30% viewed it as "very operator dependent." The overall support for mandated pulse oximetry screening was 55%. The support for mandate decreased with years of experience, with 76% of the supporters having less than 5 years, 58% of those having 5 to 10 years, 53% of those having 10 to 20 years, and 51% of those having more than 20 years of experience.

CONCLUSIONS

Pediatric cardiologists recognize that current practice is inadequate for detecting significant CHD. Slightly more than half of the pediatric cardiologists in this study supported a mandate for pulse oximetry screening, but there were many concerns, and the support decreased with increasing years of clinical experience.