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Should we start a nationwide screening program for critical congenital heart disease in Turkey? A pilot study on four centres with different altitudes

Published online by Cambridge University Press:  08 April 2019

Dilek Dilli ,
Vehbi Doğan ,
Banu M. Özyurt ,
Abdullah Özyurt ,
Nilay Hakan ,
Sibel Bozabalı ,
İbrahim Caner ,
Haşim Olgun ,
Murat Koç  and
İrfan Taşoğlu
...Show all authors
Dilek Dilli*
Affiliation:
Neonatology Department, Health Science University, Dr Sami Ulus Research and Application Center, Ankara, Turkey
Vehbi Doğan
Affiliation:
Pediatric Cardiology Department, Health Science University, Dr Sami Ulus Research and Application Center, Ankara, Turkey
Banu M. Özyurt
Affiliation:
Neonatology Department, Mersin Maternity and Children Hospital, Mersin, Turkey
Abdullah Özyurt
Affiliation:
Pediatric Cardiology Department, Mersin Maternity and Children Hospital, Mersin, Turkey
Nilay Hakan
Affiliation:
Neonatology Department, Muğla Sıtkı Koçman University, Muğla, Turkey
Sibel Bozabalı
Affiliation:
Pediatric Cardiology Department, Muğla Sıtkı Koçman University, Muğla, Turkey
İbrahim Caner
Affiliation:
Neonatology Department, Atatürk University, Erzurum, Turkey
Haşim Olgun
Affiliation:
Pediatric Cardiology Department, Atatürk University, Erzurum, Turkey
Murat Koç
Affiliation:
Pediatric Cardiovascular Surgery Department, Health Science University, Dr Sami Ulus Research and Application Center, Ankara, Turkey
İrfan Taşoğlu
Affiliation:
Pediatric Cardiovascular Surgery Department, Turkiye Yuksek İhtisas Training and Research Hospital, Ankara, Turkey
Selmin Karademir
Affiliation:
Pediatric Cardiology Department, Health Science University, Dr Sami Ulus Research and Application Center, Ankara, Turkey
Ayşegül Zenciroğlu
Affiliation:
Neonatology Department, Health Science University, Dr Sami Ulus Research and Application Center, Ankara, Turkey
*
Author for correspondence: Dilek Dilli, MD, Associate Professor, Health Science University, Dr Sami Ulus Research and Application Center, Ankara, Turkey. Tel: + 90 312 4123208; Fax: +3124123056013; E- mail: [email protected]
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Abstract

Background:

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.

Methods:

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.

Results:

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.

Conclusion:

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.

Keywords

Critical congenital heart diseasescreeningnewbornpulse oximetry
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 4 , April 2019 , pp. 475 - 480
Copyright
© Cambridge University Press 2019 

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