EARLY DETECTION OF CONGENITAL CARDIOVASCULAR DEFECTS IN NEONATES

Abstract

Congenital cardiovascular defect (CCVD) is an abnormality in cardio-circulatory structure or function that is present at birth or diagnosed in adulthood. It is one of the most common congenital malformations that accounts for half of all deaths from lethal malformations in children. Almost one third to one half of CCVDs are severe and lethal unless an intervention is done early.

The aim of the present study was to determine if pulse oximeter coupled with accurate clinical examination are useful tools for the early detection of congenital cardiovascular defects.

A systematic random sample was recruited from the nursery unit of neonates born in Kasr el Aini Hospital, Cairo University, over a period of one year starting from June 2006 till the end of May 2007. The incidence of CCVD was 48/1,000 live births, denoting the importance of the early detection of CCVD. Life-threatening or critical CCVD was defined as those with lesions that without intervention in the neonatal period would be fatal.

Our study was based on determination of preductal and postductal saturations 95%. On adding PO to diastolic blood pressure difference in the lower limb >10 mmHg lower than the right upper limb improved the detection of CoA to 100% sensitivity, which may be fatal if missed. Besides, PO augmented clinical examination in the early detection of both cyanotic and critical cases. The sensitivity of clinical examination alone was 53.3% that improved and the specificity was high with PO cut off point 95%.

In conclusion, PO is an easily applied, non-invasive and specific tool for the early detection of CCVD. Pulse oximeter does not serve as a substitute, but it augments a careful clinical examination. Therefore, the strategy of adding PO to clinical examination appears to obtain better results in the early detection of CCVD in a timely manner and can truly help save lives. Consequently, this screening should become a part of the discharge sheet from the nursery care unit for every newborn. Further studies are necessary to determine cost-effectiveness.