Children's National Heart Institute, Children's National Hospital, Washington, District of Columbia;
School of Medicine, The George Washington University, Washington, District of Columbia.
Pediatrics. 2020 Jul;146(1). doi: 10.1542/peds.2019-1650. Epub 2020 Jun 4.
Seven years after its addition to the US Recommended Uniform Screening Panel, newborn screening for critical congenital heart disease (CCHD) using pulse oximetry became mandatory in the United States. Although CCHD newborn screening reduces morbidity and mortality, there remain important opportunities to improve. An expert panel convened for a 1-day meeting in September 2018, including subject matter experts and representatives from stakeholder organizations. Presentations on CCHD outcomes, variations in approach to screening, and data and quality improvement helped identify improvement opportunities. The expert panel concluded that sufficient evidence exists to recommend modifying the current American Academy of Pediatrics algorithm by (1) requiring an oxygen saturation of at least 95% in both (formerly either) the upper and lower extremities to pass and (2) requiring only 1 repeat screen instead of 2 for cases that neither pass nor fail initially. The panel underscored the importance of improving public health reporting by further specifying the targets of screening and criteria for reporting outcomes (false-negative and false-positive cases). The panel also highlighted the need to ensure sufficient public health funding for CCHD newborn screening and opportunities for education and global implementation. Newborn screening for CCHD using pulse oximetry has led to significant improvements in child health outcomes. However, further important work is required to understand and improve the effectiveness and efficiency of screening.
在美国推荐的统一筛查小组中加入七年后，使用脉搏血氧仪对严重先天性心脏病（CCHD）进行新生儿筛查在美国成为强制性要求。虽然 CCHD 新生儿筛查降低了发病率和死亡率，但仍有重要的改进机会。一个专家小组于 2018 年 9 月召开了为期一天的会议，包括主题专家和利益相关者组织的代表。关于 CCHD 结果、筛查方法的差异以及数据和质量改进的介绍有助于确定改进机会。专家小组得出结论，有足够的证据表明可以修改当前的美国儿科学会算法，（1）要求上下肢的氧饱和度均至少为 95%以通过，（2）对于既未通过也未失败的病例，仅需要进行 1 次重复筛查，而不是 2 次。该小组强调了通过进一步明确筛查目标和报告结果（假阴性和假阳性病例）的标准来改进公共卫生报告的重要性。该小组还强调需要确保 CCHD 新生儿筛查有足够的公共卫生资金，并为教育和全球实施提供机会。使用脉搏血氧仪对 CCHD 进行新生儿筛查已导致儿童健康结果的重大改善。然而，仍需要进一步的重要工作来理解和提高筛查的有效性和效率。
