Date of Award

January 2018

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Jaspreet Loyal

Abstract

Evaluation of Pulse Oximetry as a Screen for Critical Congenital Heart Disease in Newborns. Rachel E. Klausner, Eugene D. Shapiro, Robert W. Elder, Eve Colson and Jaspreet Loyal. Department of Pediatrics, Yale University, School of Medicine, New Haven, CT.

The objective of this study was to report the results of and identify problems with a screening program using differential pulse oximetry (POx) to detect critical congenital heart disease (CCHD) in newborns. Charts of all infants born at four Yale New Haven Health hospitals in Connecticut between January 1 and December 31, 2014 were reviewed. Of 10,589 newborns, 171 (1.6%) underwent an echocardiogram before screening, 10,320 (97.5%) were screened by POx, and 98 (0.9%) were not screened. Of thirteen newborns (0.1%) diagnosed with CCHD, eleven (85%) were suspected of having CCHD on the basis of prenatal ultrasound, 1 (8%) was diagnosed due to clinical concern prior to screening, and 1 (8%) had a negative screening result but was subsequently diagnosed by echocardiogram following auscultation of a murmur. No infants with CCHD were identified through POx screening (POxS) alone. Four infants with a positive POx screen showed noncritical cardiac lesions by echocardiogram. The majority of infants were screened within the recommended 24 to 72 hours of life and had screens that were interpreted and documented correctly. Of 10,316 infants with negative POx screens, 52.1% remained in the Yale New Haven Health system at 1 year of age and no CCHD lesions were listed in their charts. Although a CCHD screening program was effectively implemented, perhaps due to high antenatal detection rates (85%), POxS did not lead to a substantial increase in the early identification of CCHDs in our hospital system.

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