Dilli Dilek, Doğan Vehbi, Özyurt Banu M, Özyurt Abdullah, Hakan Nilay, Bozabalı Sibel, Caner İbrahim, Olgun Haşim, Koç Murat, Taşoğlu İrfan, Karademir Selmin, Zenciroğlu Ayşegül
Neonatology Department,Health Science University, Dr Sami Ulus Research and Application Center,Ankara,Turkey.
Pediatric Cardiology Department,Health Science University, Dr Sami Ulus Research and Application Center,Ankara,Turkey.
Cardiol Young. 2019 Apr;29(4):475-480. doi: 10.1017/S1047951119000052. Epub 2019 Apr 8.
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.
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.
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.
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.
在全国性筛查项目实施之前，调查在土耳其四个不同海拔地理区域通过脉搏血氧饱和度测定法进行危重型先天性心脏病（CCHD）筛查试验的可行性。
这是一项前瞻性多中心研究，于2015年12月至2017年5月在四个中心开展。在出生后早期使用Masimo Radical-7测量导管前和导管后的血氧饱和度及灌注指数（PI）。根据美国儿科学会推荐的算法对结果进行评估。此外，PI值<0.7被认为具有显著性。
在4888名新生儿中，平均筛查时间为31.5±12.1小时。首次测量时，导管前和导管后测量的平均值分别为：饱和度97.3±1.8%，PI 2.8±2.0，以及饱和度97.7±1.8%，PI 2.3±1.3。导管前饱和度、PI以及导管后饱和度在海拔最高的中心4最低。总体试验阳性率为0.85%（n = 42）。在6名婴儿（0.12%）中检测出CCHD。其中，与非CCHD及正常变异婴儿相比，患CCHD婴儿的右手（91±6.3）和足部饱和度（92.1±4.3%）较低（所有比较p<0.05）。该试验的敏感性、特异性、阳性和阴性预测值以及似然比分别为：83.3%、99.9%、11.9%、99.9%和99.2%。
本研究得出结论认为，脉搏血氧饱和度测定法筛查是不同海拔地区新生儿先天性心脏病的有效筛查工具。我们支持在我国实施考虑海拔差异的全国性筛查项目。
