Zhang Yu-Lin, Bai Hai-Tao
Department of Pediatric, Jinjiang Municipal Hospital, Jinjiang, People's Republic of China.
Department of Pediatrics, First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China.
Int J Gen Med. 2021 Jun 17;14:2599-2609. doi: 10.2147/IJGM.S311582. eCollection 2021.
This study explored the feasibility of congenital heart disease (CHD) screening by combining a percutaneous oxygen saturation (POX) test with cardiac auscultation method in neonates.
POX tests and cardiac auscultation were used concurrently to screen 8305 neonates born in Jinjiang City Hospital between January 2016 and December 2018 for CHD. The positive screening results (positive POX or positive cardiac auscultation) were confirmed with echocardiography, while any false negative results were identified through follow-up and parent feedback. Sensitivity, specificity, positive/negative predictive values, Youden's index, and the area under the receiver operator characteristic curve (AUC) of the single use and combined use of the two methods (a POX test and auscultation) were calculated, and the results were compared.
Among 8305 neonates, 22 cases were positive for POX alone, of which 6 cases were diagnosed by echocardiography; 83 cases were positive for cardiac auscultation alone, of which 47 cases were diagnosed by echocardiography; and 8 cases were positive for both methods, all of which were confirmed by echocardiography. Four more cases were confirmed during follow-up. Sensitivity, specificity, and the positive and negative predictive values of combined screening were 93.85%, 99.37%, 53.98% and 99.95%, respectively, while Youden's index was 0.93, and the AUC was 0.966. Sixty-five cases of CHD were diagnosed, the total incidence being 7.82%, and a ventricular septal defect was found to be the most common type.
The combination of POX test and cardiac auscultation as a screening method for neonatal CHD can reduce missed diagnoses and increase the detection rate of CHD in newborn infants.
本研究探讨经皮血氧饱和度（POX）检测与心脏听诊法相结合用于新生儿先天性心脏病（CHD）筛查的可行性。
2016年1月至2018年12月期间，对晋江市医院出生的8305例新生儿同时采用POX检测和心脏听诊进行CHD筛查。筛查结果阳性（POX阳性或心脏听诊阳性）者采用超声心动图进行确诊，而任何假阴性结果则通过随访及家长反馈来确定。计算两种方法（POX检测和听诊）单独使用及联合使用时的灵敏度、特异度、阳性/阴性预测值、约登指数以及受试者工作特征曲线下面积（AUC），并对结果进行比较。
8305例新生儿中，单纯POX阳性22例，其中6例经超声心动图确诊；单纯心脏听诊阳性83例，其中47例经超声心动图确诊；两种方法均阳性8例，均经超声心动图确诊。随访期间又确诊4例。联合筛查的灵敏度、特异度、阳性和阴性预测值分别为93.85%、99.37%、53.98%和99.95%，约登指数为0.93，AUC为0.966。共确诊CHD 65例，总发病率为7.82%，其中室间隔缺损最为常见。
POX检测与心脏听诊相结合作为新生儿CHD的筛查方法可减少漏诊，提高新生儿CHD的检出率。
