Jones Andrew J, Howarth Claire, Nicholl Richard, Mat-Ali Ezam, Knowles Rachel
1Neonatal Intensive Care Unit,Northwick Park Hospital,Harrow,Middlesex,United Kingdom.
2UCL Institute of Child Health,London,United Kingdom.
Cardiol Young. 2016 Oct;26(7):1397-405. doi: 10.1017/S1047951115002784. Epub 2016 Feb 24.
The objective of this study was to evaluate the impact and efficacy of pulse oximetry screening for CHD in a level-two neonatal unit without on-site access to paediatric echocardiography.
All neonatal unit admissions between 1 September, 2011 and 31 August, 2013 were reviewed to determine the outcomes of newborns identified by pulse oximetry screening. Record linkage with the National Congenital Heart Disease Audit allowed follow-up of newborns with a negative screening result.
There were 11,233 live births during the study period, with 973 neonatal unit admissions unrelated to pulse oximetry screening. From the remaining screening population of 10,260 newborns, 23 were admitted on the basis of a screen-positive result; three of the 23 patients went on to have urgent echocardiograms, and two were found to have critical CHD. In the 21 newborns without critical CHD, an alternative diagnosis was made in 16 cases. Record linkage with the National Congenital Heart Disease Audit indicated that no newborns born in the hospital during the study period received surgery for critical CHD following negative screening. The estimated sensitivity of screening was 100% (95% confidence interval 15.81-100%) and specificity was 99.80% (95% confidence interval 99.69-99.87%), with a false-positive rate of 0.20% (95% confidence interval 0.13-0.31%).
The introduction of pulse oximetry screening to a hospital where paediatric echocardiography services are not available is practical, results in very few referrals to the regional paediatric cardiology centre, and detects cases of CHD that would otherwise go undiagnosed. Record linkage with a national CHD database provides a straightforward method for tracking cases of CHD that may have been missed by screening.
本研究的目的是评估在没有现场儿科超声心动图检查条件的二级新生儿病房中，脉搏血氧饱和度筛查对先天性心脏病（CHD）的影响和效果。
回顾了2011年9月1日至2013年8月31日期间所有入住新生儿病房的病例，以确定通过脉搏血氧饱和度筛查识别出的新生儿的结局。与国家先天性心脏病审计进行记录链接，以便对筛查结果为阴性的新生儿进行随访。
研究期间共有11233例活产，其中973例新生儿入住与脉搏血氧饱和度筛查无关。在其余10260例筛查人群中，23例因筛查结果为阳性而入院；这23例患者中有3例接受了紧急超声心动图检查，其中2例被发现患有严重先天性心脏病。在21例无严重先天性心脏病的新生儿中，16例有其他诊断。与国家先天性心脏病审计的记录链接表明，研究期间在该医院出生的新生儿在筛查结果为阴性后均未接受严重先天性心脏病手术。筛查的估计灵敏度为100%（95%置信区间15.81 - 100%），特异性为99.80%（95%置信区间99.69 - 99.87%），假阳性率为0.20%（95%置信区间0.13 - 0.31%）。
在没有儿科超声心动图服务的医院引入脉搏血氧饱和度筛查是可行的，转诊至区域儿科心脏病中心的情况极少，并能检测出原本会漏诊的先天性心脏病病例。与国家先天性心脏病数据库进行记录链接提供了一种直接的方法来追踪可能因筛查而漏诊的先天性心脏病病例。
