Clinical screening for congenital heart disease at birth: A prospective study in a community hospital in Kerala
Publication Type:Journal Article
Source:Indian Pediatrics, Volume 48, Number 1, p.25-30 (2011)
Keywords:abnormal laboratory result, article, clinical evaluation, clinical feature, community hospital, Congenital, congenital heart disease, controlled clinical trial, controlled study, cyanosis, diagnostic error, diagnostic test accuracy study, diagnostic value, echocardiography, female, Heart Defects, heart murmur, human, Humans, India, infant, longitudinal study, major clinical study, male, Neonatal Screening, newborn, newborn screening, Oximetry, Prognosis, Prospective Studies, pulse oximetry, sensitivity and specificity
Objective: To develop a clinical strategy for detection of Congenital heart disease (CHD) in the newborn through a combination of clinical signs and pulse oximetry. Design: Prospective longitudinal study. Setting: Community level hospital in the city of Kochi, Kerala. Participants and interventions: All consecutive newborns between June 2006 and February 2009 were prospectively screened for CHD, 48 hours after birth. The on-site pediatrician performed clinical screening. A study nurse recorded pulse oximetry in a lower extremity; value of <94% was defined as abnormal. Echocardiography was performed on site by a trained research officer. A 6-week clinical follow-up evaluation was done for all. Main outcome measure: Detection of CHD by echocardiography. Results: Of 5487 babies screened, 425 (7.75%) had CHD. 17 (0.31%) had major CHD, two of whom (one ALCAPA and one large VSD) were missed during the initial evaluation. The rest were minor CHD (408 patients, 7.44%), most of which normalized by 6 weeks. On multivariate analysis, murmur, central cyanosis, abnormal precordial pulsations and abnormal pulse oximetry emerged as significant predictors of CHD. The sensitivity of clinical evaluation and pulse oximetry combined was 19% for all CHDs and 20% for major CHD; specificity was 88%. Conclusions: In the community setting of a developing country, clinical evaluation and pulse oximetry after birth had a very low sensitivity for detection of CHD. Though an abnormal screening warrants prompt echocardiography, a 6-week clinical evaluation is recommended to ensure that major CHD is not missed. © 2011 Indian Academy of Pediatrics.
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