Aamir Tajwar, Kruse Lakota, Ezeakudo Osita
New Jersey Department of Health and Senior Services, Division of Family Health Services, Trenton, New Jersey 08625, USA.
Acta Paediatr. 2007 Aug;96(8):1146-9. doi: 10.1111/j.1651-2227.2007.00389.x. Epub 2007 Jun 21.
Congenital cardiovascular malformations (CCVMs) are relatively common with a prevalence of 5-10 per 1000 live births. Pulse oximetry screening is proposed to identify newborns with critical CCVMs which are missed by routine prenatal ultrasound and by pre-discharge physical examinations. The purpose of this study was to identify the number of infants with a delayed diagnosis of critical CCVMs potentially detectable by pre-discharge pulse oximetry screening.
Hospital Discharge records in New Jersey from 199-2004 for infants with critical CCVMs were identified using ICD-9 codes. These records were matched to the Electronic Birth Certificate records to identify newborns who were discharged as normal newborns and were later admitted with a diagnosis of critical CCVMs. Chart review was completed on these cases to confirm a delay in diagnosis.
Chart reviews confirmed delayed diagnosis of critical CCVM in 47 infants out of 670,245 births. Coarctation of the Aorta was the most common delayed diagnosis. The age at final diagnosis varied from 3 days to 6.5 months.
Further examination of pulse oximetry as a routine newborn screening service is warranted. Implementation of pre-discharge pulse oximetry screening for newborns may improve the timely detection of asymptomatic critical CCVMs.
先天性心血管畸形（CCVMs）相对常见，活产儿中的患病率为千分之五至十。有人提议采用脉搏血氧饱和度筛查来识别患有严重CCVMs的新生儿，这些患儿在常规产前超声检查和出院前体格检查中未被发现。本研究的目的是确定那些可能通过出院前脉搏血氧饱和度筛查检测出的严重CCVMs诊断延迟的婴儿数量。
利用国际疾病分类第九版（ICD - 9）编码识别1999年至2004年新泽西州患有严重CCVMs婴儿的医院出院记录。将这些记录与电子出生证明记录相匹配，以识别那些作为正常新生儿出院、后来又因严重CCVMs诊断而入院的新生儿。对这些病例进行病历审查以确认诊断延迟。
病历审查证实，在670245例出生婴儿中，有47例婴儿的严重CCVMs诊断延迟。主动脉缩窄是最常见的诊断延迟情况。最终诊断时的年龄从3天到6.5个月不等。
有必要进一步研究将脉搏血氧饱和度作为一项常规新生儿筛查服务。对新生儿实施出院前脉搏血氧饱和度筛查可能会改善对无症状严重CCVMs的及时检测。
