Neonatal Medicine

The Korean Society of Neonatology (대한신생아학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical Features of Critical Congenital Heart Disease in Term Infants with Hypoxemia: A Single-Center Study in Korea

  • Choi, Eui Kyung (Department of Pediatrics, Korea University College of Medicine) ;
  • Shin, Jeong Hee (Department of Pediatrics, Korea University College of Medicine) ;
  • Jang, Gi Young (Department of Pediatrics, Korea University College of Medicine) ;
  • Choi, Byung Min (Department of Pediatrics, Korea University College of Medicine)
  • Received : 2018.04.26
  • Accepted : 2018.05.23
  • Published : 2018.11.30
⟨ Previous Next ⟩

Abstract

Purpose: This study was performed to determine the clinical features of full-term infants with hypoxemia detected by pulse oximetry and to establish the diagnosis of critical congenital heart disease (CCHD). Methods: We retrospectively reviewed the medical records of neonates who had been admitted to the neonatal intensive care unit within 2 weeks of birth at Korea University Ansan Hospital between January 2013 and October 2017 (n=450). We classified these neonates based on the presence of hypoxemia at admission and investigated neonatal characteristics, initial symptoms, echocardiographic findings, and final diagnosis associated with hypoxemic diseases. Results: Of 450 term infants, 265 infants (58.9%) were identified hypoxemia by pulse oximetry at admission. The most common symptoms of them were cyanosis and tachypnea. Among them, 80.1% of infants (214/265) were diagnosed with respiratory tract disease and 8.3% of infants (22/265) had congenital heart disease. Thirteen infants (13/265, 4.9%) had CCHD and were treated with urgent surgery or transcatheter intervention within 28 days of birth. Majority of infants with respiratory tract disorder were transferred from hospital immediately after birth, but 46.1% of infants (6/13) with CCHD remained asymptomatic after birth and were admitted after 48 hours after birth. In addition, other hypoxemic illnesses were identified as neonatal infectious and neurological diseases. Conclusion: This study showed the importance of assessment in neonates with hypoxemia, including those diagnosed with CCHD. The possibility of CCHD should be considered in the differential diagnosis in neonates demonstrating hypoxemia after 48 hours of birth. A larger prospective study is needed to assess the effectiveness and outcomes of pulse oximetry for neonatal screening in Korea.

Keywords

References

  1. Salyer JW. Neonatal and pediatric pulse oximetry. Respir Care 2003;48:386-96.
  2. Mower WR, Myers G, Nicklin EL, Kearin KT, Baraff LJ, Sachs C. Pulse oximetry as a fifth vital sign in emergency geriatric assessment. Acad Emerg Med 1998;5:858-65. https://doi.org/10.1111/j.1553-2712.1998.tb02813.x
  3. O'Brien LM, Stebbens VA, Poets CF, Heycock EG, Southall DP. Oxygen saturation during the first 24 hours of life. Arch Dis Child Fetal Neonatal Ed 2000;83:F35-8. https://doi.org/10.1136/fn.83.1.F35
  4. Levesque BM, Pollack P, Griffin BE, Nielsen HC. Pulse oximetry: what's normal in the newborn nursery? Pediatr Pulmonol 2000;30:406-12. https://doi.org/10.1002/1099-0496(200011)30:5<406::AID-PPUL7>3.0.CO;2-C
  5. Heron MP, Smith BL. Deaths: leading causes for 2003. Natl Vital Stat Rep 2007;55:1-92.
  6. Rosano A, Botto LD, Botting B, Mastroiacovo P. Infant mortality and congenital anomalies from 1950 to 1994: an international perspective. J Epidemiol Community Health 2000;54:660-6. https://doi.org/10.1136/jech.54.9.660
  7. Chung SH, Choi YS, Bae CW. Changes in the neonatal and infant mortality rate and the causes of death in Korea. Korean J Pediatr 2011;54:443-55. https://doi.org/10.3345/kjp.2011.54.11.443
  8. 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;378:785-94. https://doi.org/10.1016/S0140-6736(11)60753-8
  9. Talner CN. Report of the New England Regional Infant Cardiac Program, by Donald C. Fyler, MD, Pediatrics, 1980;65(suppl):375-461. Pediatrics 1998;102(1 Pt 2):258-9.
  10. Agrawal V, David RJ, Harris VJ. Classification of acute respiratory disorders of all newborns in a tertiary care center. J Natl Med Assoc 2003;95:585-95.
  11. Dargaville PA, Copnell B; Australian and New Zealand Neonatal Network. The epidemiology of meconium aspiration syndrome: incidence, risk factors, therapies, and outcome. Pediatrics 2006;117:1712-21. https://doi.org/10.1542/peds.2005-2215
  12. Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol 1976;33:696-705. https://doi.org/10.1001/archneur.1976.00500100030012
  13. Mitchell SC, Korones SB, Berendes HW. Congenital heart disease in 56,109 births. Incidence and natural history. Circulation 1971;43:323-32. https://doi.org/10.1161/01.CIR.43.3.323
  14. Chung ML, Lee BS, Kim EA, Kim KS, Pi SY, Oh YM, et al. Impact of fetal echocardiography on trends in disease patterns and outcomes of congenital heart disease in a neonatal intensive care unit. Neonatology 2010;98:41-6. https://doi.org/10.1159/000264673
  15. Severinghaus JW, Honda Y. History of blood gas analysis. VII. Pulse oximetry. J Clin Monit 1987;3:135-8. https://doi.org/10.1007/BF00858362
  16. Lundsgaard C, Van Slyke D, Abbott ME. Cyanosis. Can Med Assoc J 1923;13:601-4.
  17. Ainsworth S, Wyllie JP, Wren C. Prevalence and clinical significance of cardiac murmurs in neonates. Arch Dis Child Fetal Neonatal Ed 1999;80:F43-5. https://doi.org/10.1136/fn.80.1.F43
  18. 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;23:403-9. https://doi.org/10.1007/s00246-002-1482-8
  19. Plana MN, Zamora J, Suresh G, Fernandez-Pineda L, Thangaratinam S, Ewer AK. Pulse oximetry screening for critical congenital heart defects. Cochrane Database Syst Rev 2018;3:CD011912.
  20. Riede FT, Worner C, Dahnert I, Mockel 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;169:975-81. https://doi.org/10.1007/s00431-010-1160-4
  21. 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. https://doi.org/10.1136/bmj.a3037
  22. Thangaratinam S, Daniels J, Ewer AK, Zamora J, Khan KS. Accuracy of pulse oximetry in screening for congenital heart disease in asymptomatic newborns: a systematic review. Arch Dis Child Fetal Neonatal Ed 2007;92:F176-80. https://doi.org/10.1136/adc.2006.107656
  23. Kemper AR, Mahle WT, Martin GR, Cooley WC, Kumar P, Morrow WR, et al. Strategies for implementing screening for critical congenital heart disease. Pediatrics 2011;128:e1259-67. https://doi.org/10.1542/peds.2011-1317
  24. Centers for Disease Control and Prevention. Key findings: state actions to adopt newborn screening for critical congenital heart defects [Internet]. Atlanta: CDC; 2015 [cited 2018 May 24]. Available from: http://www.cdc.gov/ncbddd/heartdefects/features/states-adopt-screening.html.
  25. Mouledoux J, Guerra S, Ballweg J, Li Y, Walsh W. A novel, more efficient, staged approach for critical congenital heart disease screening. J Perinatol 2017;37:288-90. https://doi.org/10.1038/jp.2016.204
  26. Cho SY, Oh JH, Lee JH, Lee JY, Lee SJ, Han JW, et al. Recent incidence of congenital heart disease in neonatal care unit of secondary medical center: a single center study. Korean J Pediatr 2012;55:232-7. https://doi.org/10.3345/kjp.2012.55.7.232
  27. Narayen IC, Blom NA, van Geloven N, Blankman EIM, van den Broek AJM, Bruijn M, et al. Accuracy of pulse oximetry screening for critical congenital heart defects after home birth and early postnatal discharge. J Pediatr 2018;197:29-35.e1. https://doi.org/10.1016/j.jpeds.2018.01.039
  28. Jawin V, Ang HL, Omar A, Thong MK. Beyond critical congenital heart disease: newborn screening using pulse oximetry for neonatal sepsis and respiratory diseases in a middle-income country. PLoS One 2015;10:e0137580. https://doi.org/10.1371/journal.pone.0137580