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Cardiol Young. 2019 Apr;29(4):475-480. doi: 10.1017/S1047951119000052. Epub 2019 Apr 8.

Should we start a nationwide screening program for critical congenital heart disease in Turkey? A pilot study on four centres with different altitudes.

Author information

1
Neonatology Department,Health Science University, Dr Sami Ulus Research and Application Center,Ankara,Turkey.
2
Pediatric Cardiology Department,Health Science University, Dr Sami Ulus Research and Application Center,Ankara,Turkey.
3
Neonatology Department,Mersin Maternity and Children Hospital,Mersin,Turkey.
4
Pediatric Cardiology Department,Mersin Maternity and Children Hospital,Mersin,Turkey.
5
Neonatology Department,Muğla Sıtkı Koçman University,Muğla,Turkey.
6
Pediatric Cardiology Department,Muğla Sıtkı Koçman University,Muğla,Turkey.
7
Neonatology Department,Atatürk University,Erzurum,Turkey.
8
Pediatric Cardiology Department,Atatürk University,Erzurum,Turkey.
9
Pediatric Cardiovascular Surgery Department,Health Science University, Dr Sami Ulus Research and Application Center,Ankara,Turkey.
10
Pediatric Cardiovascular Surgery Department,Turkiye Yuksek İhtisas Training and Research Hospital,Ankara,Turkey.

Abstract

BACKGROUND:

To investigate the feasibility of critical congenital heart disease (CCHD) screening test by pulse oximetry in four geographical regions of Turkey with different altitudes, before implementation of a nationwide screening program.

METHODS:

It was a prospective multi-centre study performed in four centres, between December, 2015 and May, 2017. Pre- and post-ductal oxygen saturations and perfusion indices (PI) were measured using Masimo Radical-7 at early postnatal days. The results were evaluated according to the algorithm recommended by the American Academy of Pediatrics. Additionally, a PI value <0.7 was accepted to be significant.

RESULTS:

In 4888 newborns, the mean screening time was 31.5 ± 12.1 hours. At first attempt, the mean values of pre- and post-ductal measurements were: saturation 97.3 ± 1.8%, PI 2.8 ± 2.0, versus saturation 97.7 ± 1.8%, PI 2.3±1.3, respectively. Pre-ductal saturations and PI and post-ductal saturations were the lowest in Centre 4 with the highest altitude. Overall test positivity rate was 0.85% (n = 42). CCHD was detected in six babies (0.12%). Of them, right hand (91 ± 6.3) and foot saturations (92.1 ± 4.3%) were lower compared to ones with non-CCHD and normal variants (p <0.05, for all comparisons). Sensitivity, specificity, positive and negative predictive values, and likelihood ratio of the test were: 83.3%, 99.9%, 11.9%, 99.9%, and 99.2%, respectively.

CONCLUSION:

This study concluded that pulse oximetry screening is an effective screening tool for congenital heart disease in newborns at different altitudes. We support the implementation of a national screening program with consideration of altitude differences for our country.

KEYWORDS:

Critical congenital heart disease; newborn; pulse oximetry; screening

PMID:
30957737
DOI:
10.1017/S1047951119000052

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