GP27 Experience of using pulse oximetry screening in newborns to identify pulmonary hypertension and critical congenital heart defects in russia

Abstract

Background The urgency of the problem is determined by the high infant mortality and disability associated with critical CHD (CCHD) and persistent pulmonary hypertension in newborns (PPHN). The difficulty of diagnosing critical CHD and persistent pulmonary hypertension in newborns leads to a delayed accurate diagnosis, which is the cause of late hospitalization in specialized hospitals in a difficult and often critical condition. This research paper presents a method for the early detection of newborns with PPHN and critical CHD using pulse oximetry, which differs from the existing methods by the beginning of the saturation measurement time, as well as an extended diagnostic search for conditions that threaten the life of the newborn. Purpose Assess the diagnostic value of pulse oximetry conducted by an infant at an earlier period (at 3 o’clock after birth) in order to identify newborns with persistent pulmonary hypertension and critical congenital heart defects. Methods The work was carried out on the basis of the maternity hospital of the Republic of Tatarstan of the Russian Federation. The study included all newborns born alive for a period of more than 34 weeks of gestational age without prenatally confirmed pathology of the cardiovascular and pulmonary systems. Newborns are screened twice: in the third hour of life, which ensures early diagnosis of persistent pulmonary hypertension of newborns and critical CHD, and on the 3rd day after birth, that is, before vaccination against tuberculosis, since vaccination may worsen the condition of a newborn with undiagnosed pathology. Pulse oximetry is performed at any time if the newborn has any clinical manifestations of critical conditions. Results For the period from April 2016 to December 2017 screening covered 19,110 newborns. Positive screening results were obtained in 242 patients. Thanks to screening, in 29 newborns in the first hours of life, congenital heart defects that were not diagnosed prenatal were detected, 6 of them were critical. All newborns with critical CHD were transferred for emergency indications to the cardiac surgery department and successfully operated. Persistent pulmonary hypertension was detected in 34 patients. Congenital pneumonia was diagnosed in 104 newborns. Conclusion Early detection of life-threatening conditions allowed time to begin therapy, to avoid deaths and critical complications. In addition, during the screening, other concomitant conditions accompanied by hypoxemia were also diagnosed. In addition to the early detection of critical CHD using pulse oximetric screening, other diseases can be identified, including persistent pulmonary hypertension of the newborn and congenital pneumonia.