Clinical Features of Critical Congenital Heart Disease in Term Infants with Hypoxemia: A Single-Center Study in Korea
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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.
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.
참고문헌 (28)
- Salyer JW, "Neonatal and pediatric pulse oximetry", Respir Care, 48, pp.386~396 (2003)
- Mower WR, "Pulse oximetry as a fifth vital sign in emergency geriatric assessment", Acad Emerg Med, 5, pp.858~865 (1998)
- O'Brien LM, "Oxygen saturation during the first 24 hours of life", Arch Dis Child Fetal Neonatal Ed, 83, pp.F35~F38 (2000)
- Levesque BM, "Pulse oximetry: what's normal in the newborn nursery", Pediatr Pulmonol, 30, pp.406~412 (2000)
- Heron MP, "Deaths: leading causes for 2003", Natl Vital Stat Rep, 55, pp.1~92 (2007)
- Rosano A, "Infant mortality and congenital anomalies from 1950 to 1994: an international perspective", J Epidemiol Community Health, 54, pp.660~666 (2000)
- Sung-Hoon Chung, "Changes in the neonatal and infant mortality rate and the causes of death in Korea", Clinical and Experimental Pediatrics, 54(11), pp.443~455 (2011), 대한소아청소년과학회
- Ewer AK, "Pulse oximetry screening for congenital heart defects in newborn infants (PulseOx): a test accuracy study", Lancet, 378, pp.785~794 (2011)
- Talner CN, "Report of the New England Regional Infant Cardiac Program, by Donald C. Fyler, MD", Pediatrics, 102(1 Pt 2), pp.258~259 (1998)
- Agrawal V, "Classification of acute respiratory disorders of all newborns in a tertiary care center", J Natl Med Assoc, 95, pp.585~595 (2003)
- Dargaville PA, "The epidemiology of meconium aspiration syndrome: incidence, risk factors, therapies, and outcome", Pediatrics, 117, pp.1712~1721 (2006)
- Sarnat HB, "Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study", Arch Neurol, 33, pp.696~705 (1976)
- Mitchell SC, "Congenital heart disease in 56,109 births. Incidence and natural history", Circulation, 43, pp.323~332 (1971)
- Chung ML, "Impact of fetal echocardiography on trends in disease patterns and outcomes of congenital heart disease in a neonatal intensive care unit", Neonatology, 98, pp.41~46 (2010)
- Severinghaus JW, "History of blood gas analysis. VII. Pulse oximetry", J Clin Monit, 3, pp.135~138 (1987)
- Lundsgaard C, "Cyanosis", Can Med Assoc J, 13, pp.601~604 (1923)
- Ainsworth S, "Prevalence and clinical significance of cardiac murmurs in neonates", Arch Dis Child Fetal Neonatal Ed, 80, pp.F43~F45 (1999)
- Hoke TR, "Oxygen saturation as a screening test for critical congenital heart disease: a preliminary study", Pediatr Cardiol, 23, pp.403~409 (2002)
- Plana MN, "Pulse oximetry screening for critical congenital heart defects", Cochrane Database Syst Rev, 3, pp.CD011912~ (2018)
- Riede FT, "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, 169, pp.975~981 (2010)
- de-Wahl Granelli A, "Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: a Swedish prospective screening study in 39,821 newborns", BMJ, 338, pp.a3037~ (2009)
- Thangaratinam S, "Accuracy of pulse oximetry in screening for congenital heart disease in asymptomatic newborns: a systematic review", Arch Dis Child Fetal Neonatal Ed, 92, pp.F176~F180 (2007)
- Kemper AR, "Strategies for implementing screening for critical congenital heart disease", Pediatrics, 128, pp.e1259~e1267 (2011)
- "Key findings: state actions to adopt newborn screening for critical congenital heart defects" (2015)[URL]
- Mouledoux J, "A novel, more efficient, staged approach for critical congenital heart disease screening", J Perinatol, 37, pp.288~290 (2017)
- Seon Young Cho, "Recent incidence of congenital heart disease in neonatal care unit of secondary medical center: a single center study", Clinical and Experimental Pediatrics, 55(7), pp.232~237 (2012), 대한소아청소년과학회
- Narayen IC, "Accuracy of pulse oximetry screening for critical congenital heart defects after home birth and early postnatal discharge", J Pediatr, 197, pp.29~35.e1 (2018)
- Jawin V, "Beyond critical congenital heart disease: newborn screening using pulse oximetry for neonatal sepsis and respiratory diseases in a middle-income country", PLoS One, 10, pp.e0137580~ (2015)