Top PDF Screening for congenital heart disease in newborns at urban community health centre

Screening for congenital heart disease in newborns at urban community health centre

Screening for congenital heart disease in newborns at urban community health centre

study is higher than that reported previously from various population based studies. This is accountable by the detection of minor, self-resolving lesions due to use of echocardiography for screening all babies. Though murmur, cyanosis and abnormal pulse oximetry were identified as predictors of CHD, the sensitivity of these signs to detect CHD were very low (combined clinical evaluation and pulse oximetry were positive in 22.8% of babies only.

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Role of clinical examination and pulse oximetry in screening for  congenital heart disease in newborns

Role of clinical examination and pulse oximetry in screening for congenital heart disease in newborns

According to Mitchell and colleagues 6 definition, congenital heart disease is a gross structural malformation of the heart disease or great intrathoracic vessels with a real or potential functional importance. Early recognition of Congenital Heart Disease (CHD) is of crucial importance because clinical presentation and deterioration may be sudden. Clinical examination for the early signs of CHD is an essential part of routine neonatal examination and can identify some asymptomatic newborns. Pulse oximetry has been suggested as a screening tool for the early detection of CHD in asymptomatic newborns, because the physical examination alone appears to be insufficient.
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Can echocardiographic screening in the early days of life detect critical congenital heart disease among apparently healthy newborns?

Can echocardiographic screening in the early days of life detect critical congenital heart disease among apparently healthy newborns?

Heart defects are the most common congenital malforma- tions, with an incidence of approximately eight per 1000 live births [1], while the incidence of critical congenital heart disease (CCHD) is one or two per 1000 newborn babies [2]. In general, CCHD is defined as congenital heart disease (CHD) that leads to death or requires surgery or catheter intervention within 28 days of life [3]. Delayed detection of CCHD increases the risk of acute cardiovascu- lar collapse and death, and is associated with worse out- comes of interventions [2, 4]. As the preference for early discharge after delivery is becoming more prevalent, newborns with CCHD are more likely to develop symp- toms at home rather than during their stay in the newborn nursery. Screening for CCHD has previously relied on prenatal ultrasound and postnatal clinical examination, but both such approaches are known to have a relatively low detection rate; it is estimated that up to a third of newborns may be discharged with undiagnosed critical defects [5]. For more than a decade, many studies have assessed the usefulness of pulse oximetry for improving the detection of CCHD in newborns before hospital discharge (typically, in the newborn nursery); evidence from such studies indicates that pulse oximetry screening is highly effective in detecting CCHD in newborns with hypoxemia [6, 7] but not in those without hypoxemia [3, 8]. Echocardiography, especially when performed by pediatric cardiologists, is commonly used for diagnosing CHD, and thus may be helpful in detecting CCHD in newborns earlier and with higher sensitivity than when using other screening methods. How- ever, few studies have assessed the effectiveness of hospital-wide echocardiography screening for CHD in newborns [9–11]. The objective of the present study was to evaluate the effectiveness of echocardiographic screening for CCHD when evaluations are performed by pediatric cardiologists in a tertiary care center.
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Pulse oximetry screening: a review of diagnosing critical congenital heart disease in newborns

Pulse oximetry screening: a review of diagnosing critical congenital heart disease in newborns

in 2000 described the normal range of oxygen saturations in term newborns in the first days of life. These investigators evaluated normal oximetry values at sea level, from admis- sion to the newborn nursery to discharge. They also evaluated variables such as sex, gestational age at birth, birth weight, mode of delivery, Apgar scores, pre- or postductal site of measurement, and status of the infant at the time of measure- ment (sleeping, quiet, and crying). Pulse oximetry measure- ments were taken upon admission to the newborn nursery, at 24 hours of life, and at discharge. The overall oxygenation saturation was 97.2% ± 1.6% (95% CI 97.1%–97.2%). 21
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Cost-Effectiveness of Routine Screening for Critical Congenital Heart Disease in US Newborns

Cost-Effectiveness of Routine Screening for Critical Congenital Heart Disease in US Newborns

double-outlet right ventricle, Ebstein anomaly, hypoplastic left heart syn- drome, pulmonary atresia (intact sep- tum), single ventricle, tetralogy of Fallot, total anomalous pulmonary ve- nous connection, tricuspid atresia, and truncus arteriosus. Although screen- ing might also detect critical forms of aortic and pulmonary stenosis, we did not include those conditions because administrative diagnostic codes (In- ternational Classi fi cation of Diseases, Ninth Revision, Clinical Modi fi cation) from which we derived clinical in- formation do not distinguish critical

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Effectiveness of Pulse Oximetry Screening for Congenital Heart Disease in Asymptomatic Newborns

Effectiveness of Pulse Oximetry Screening for Congenital Heart Disease in Asymptomatic Newborns

Oximetric screening was performed on 11 281 asymptomatic newborns during the study interval: 8642 at hospital A and 2639 at hospital B (Table 2). Three cases of CCVM were detected, including 2 patients with total anomalous pulmonary venous return (oxygen saturation by pulse oximeter: 92%, 88%) and 1 patient with truncus arteriosus (oxygen saturation by pulse oximeter: 86%; Table 3). There- fore, 1 in 3760 asymptomatic newborns was found to have a CCVM by oximetric screening before dis- charge. There was no accrued cost as reusable oxime- ter probes were used with oximeters already in place in the nurseries. There was 1 false-positive screen. An asymptomatic infant underwent echocardiogra- phy for postductal desaturation and was found to have a structurally normal heart with persistent right to left ductal shunting as a result of delayed transi- tion from the fetal to the neonatal circulation. Two screened infants were readmitted (coarctation, hyp- oplastic left pulmonary artery with aorto-pulmonary collaterals). Other cardiac diagnoses in the database search were nonurgent, including cases of patent foramen ovale, peripheral pulmonic stenosis, and ventricular septal defect. The prevalence of all cases of critical CCVM in the total population was 1 in 564, whereas in the screened population it was 1 in 2256.
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Implementation of Critical Congenital Heart Disease Screening in Minnesota

Implementation of Critical Congenital Heart Disease Screening in Minnesota

delivery) or emphasis on early dis- charge. Although the mean time re- quired for screening was 5.5 minutes and did not change signi fi cantly during the study period, there was a wide range of time required. Some of the screening outliers may have included time spent discussing the screen with parents, despite instructions not to include this in the reported time. The study identi fi ed signi fi cant compli- ance problems with the recommended algorithm, leading to unnecessary re- testing or echocardiography and to newborns being discharged without completing evaluation for failed screens. These compliance failures demonstrate the need for rigorous initial training and frequent training updates for screening staff. In addition, we would recommend coupling data collection to electronic medical record systems with an auto- matic noti fi cation feature triggered by
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Strategies for Implementing Screening for Critical Congenital Heart Disease

Strategies for Implementing Screening for Critical Congenital Heart Disease

The work group chose to focus initially on screening in the well-infant nursery because of the risk of missed cases of CCHD among healthy-appearing newborns. The work group recog- nized the importance of also consid- ering screening within NICUs. How- ever, developing a simple algorithm for the NICU setting is challenging be- cause of the heterogeneity of underly- ing conditions (eg, prematurity, meconium-aspiration syndrome, sep- sis). Unlike the well-infant nursery, many infants in the NICU undergo re- peated medical evaluations, are moni- tored by pulse oximetry, and have lon- ger lengths of stay. However, there was concern that screening only in well-infant nurseries would miss new- borns with short stays in intermediate care nurseries. The work group en- dorsed screening infants in intermedi- ate care nurseries or other units in which discharge is common in the first week by using the work-group protocol for screening in the well-infant nurs- ery. The work group chose not to focus on out-of-hospital births, which raise challenging coordination-of-care is- sues, which will be addressed in the future.
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Oxygen Saturation Nomogram in Newborns Screened for Critical Congenital Heart Disease

Oxygen Saturation Nomogram in Newborns Screened for Critical Congenital Heart Disease

91 newborns required a repeat screen, 75% of which were triggered by a . 3% difference; 90% passed the repeat screen. The number of CCHD cases in our study is too small to make any ar- gument regarding single postductal versus pre- and postductal screens. In fact, the cumulative published satura- tion experience to date may still be in- suf fi cient to make conclusions about the optimal methodology for CCHD screen- ing. Regardless of what methodology is used, ongoing oxygen saturation data collection in large numbers is essential to better re fi ne the thresholds for CCHD screening in the future. Furthermore, cost effectiveness analysis need to be performed to address whether the added cost of both pre and postductal screening justify the bene fi t of increase in sensitivity to detect CCHD.
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Factors Associated With Late Detection of Critical Congenital Heart Disease in Newborns

Factors Associated With Late Detection of Critical Congenital Heart Disease in Newborns

This study was limited by several factors. First, the study could not control for the role of prenatal diagnosis in late de- tection because prenatal diagnosis in- formation is not available in the FBDR. According to data provided by the Florida Department of Health ’ s Bureau of Com- munity Health Assessment, the distri- bution of births according to nursery level (de fi ned as the highest nursery level available in the facility) was sig- ni fi cantly different (P , .001) for infants with CCHD (nursery level I: 18.7%; level II: 22.5%; level III: 58.7%) compared with all infants born in the same Florida hospi- tals (nursery level I: 19.6%; level II: 31.1%; level III: 49.3%). The increased fre- quency of delivery at hospitals with higher level nurseries could re fl ect mothers ’ choices or clinical advice to at- tend such birth hospitals due to prenatal diagnosis of CCHD. In particular, prenatal diagnosis of CCHD might account for the gap in the frequency of late diagnosis between infants born at hospitals with levels II and III nursery facilities. However, regardless of the explanation for the as- sociation, routine CCHD screening could reduce differences in the frequency of late diagnosis.
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Use of Pulse Oximetry Screening  in Early Detection of 
Congenital Heart Disease

Use of Pulse Oximetry Screening in Early Detection of Congenital Heart Disease

The mean preductal (right hand) and postductal (foot) SpO2 of healthy newborns at the age of 2 min has been shown to be 73% (range 44–95%) and 67% (34–93%), respectively. In that study of 50 newborns, these values increased at 10 min to 92% (65–99%) and 89% (62–99%), respectively, and in every newborn both measurements reached 95% within 1hr. The reduction in the difference between preductal and post ductal measurements reflects the diminishing ductal right to left shunt. However, a slower disappearance of the shunt has been seen in 4–5% among larger populations. Thus, use of SpO2 for screening is not practical before the age of 1–2 h. Thereafter, the normal baseline SpO2 is quite stable at about 98%, except for short periods when it is lower, in particular during feeding and apnoeic spells 10, 64-66 .
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Endorsement of Health and Human Services Recommendation for Pulse Oximetry Screening for Critical Congenital Heart Disease

Endorsement of Health and Human Services Recommendation for Pulse Oximetry Screening for Critical Congenital Heart Disease

added to the recommended uniform screening panel (RUSP). This rec- ommendation was based in large part on the Secretary ’ s Advisory Committee on Heritable Disorders in Newborns and Children ’ s recommendations and a 2-day comprehensive evidence re- view of screening strategies by na- tional and international stakeholders. The American Academy of Pediatrics (AAP) strongly supports the decision of the Secretary of HHS to add screening with pulse oximetry to the RUSP. The AAP has been a vigorous advocate of early detection of CCHD to prevent childhood deaths or injury that might occur as a result of late de- tection.
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Epidemiologic Features of the Presentation of Critical Congenital Heart Disease: Implications for Screening

Epidemiologic Features of the Presentation of Critical Congenital Heart Disease: Implications for Screening

Preoperative SPC, as defined in this investigation, occurs in a substantial proportion of neonates with critical CHD. An estimated 1 of every 15 000 to 26 000 live births experience SPC as a result of unrecognized CHD that would be potentially preventable by a postnatal screen- ing strategy instituted within the first 12 hours after birth or by improved prenatal detection. This incidence is comparable to that of other disorders for which new- born screening is widely available. Newborns with aortic arch obstruction are particularly vulnerable to SPC and should be targeted by any new strategies. Future studies should define the effect of SPC on outcome for addi- tional assessment of the potential impact of screening.
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Updated Strategies for Pulse Oximetry Screening for Critical Congenital Heart Disease

Updated Strategies for Pulse Oximetry Screening for Critical Congenital Heart Disease

interval: 38–181) per year and an additional 21% reduction in other or unspecified CHD deaths in states, which is equivalent to another 117 lives saved (95% con fi dence interval: 38 – 185) per year. There is no evidence that hospitals are facing a signi fi cant increased clinical burden from POS despite earlier concerns of delayed discharges and possible unnecessary echocardiograms after failed screening. In the United States, the percentage of POS test-positive newborns who require further diagnostic testing has been low. From 2012 to 2015, demonstration projects in 10 US states showed that there were only 645 of 708 318 (0.09%) newborns testing positive, with only 58 of these newborns (9%) having a CCHD diagnosis. 21 Similarly, investigators in the United Kingdom have shown a low rate of failed POS, albeit a bit higher than that in the United States, possibly because screening was performed before 24 hours of age. Singh et al 22 found failing results in 208 of 25 859 newborns (0.8%) when testing was performed before 24 hours of age. Congenital heart disease (CHD) was found in 17 of 208 failed screen cases (8%), and no newborns had collapse during their hospitalization.
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Spectrum of congenital heart disease in a tertiary care centre of Northern India

Spectrum of congenital heart disease in a tertiary care centre of Northern India

Burden of CHD is highly underestimated and unrecognised, especially in this part of the country. This study included large number of patients over period of 2 years from main paediatric centre of the Kashmir valley. Hence, this study has yielded important data on epidemiology and incidence of CHDs. This study can provide observed data that can help in policy making in the health sector. This study will also provide awareness in people with family history of CHD especially where rate of consangious marriages are high. The contrasting result with respect to complex CHD in present study indicates need for good and effective antenatal cardiac screening in high risk mothers.
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Adult congenital heart disease physical activity recommendation form: a feasibility study

Adult congenital heart disease physical activity recommendation form: a feasibility study

The Physical Activity Recommendation Form Feasibility Study raised awareness and increased confidence in dis- cussing physical activity with providers for ACHA patient participants. Feasibility of use of the PARF was confirmed and felt to be beneficial by patients and providers. Baseline data analysis from the Stanford Activity Surveys revealed that ACHD survivors were not sufficiently active to attain health benefits, even with household and leisure activity included and activity not just defined as physical exercise. Additional research to improve confidence and increased physical activity in ACHD patients is needed. Further study would afford opportunity to evaluate not only in- creased motivation but the impact of PARF utilization on the actual increase in activity level with a tool to measure compliance. Possible next steps would be to have a PARF available on the ACHA website as a tool that could be downloaded by members and ACHD providers for
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A Comparative study of Plasma Fibrinogen in Male and Female patients with Coronary Artery Disease

A Comparative study of Plasma Fibrinogen in Male and Female patients with Coronary Artery Disease

Use of tobacco in the form of smoking is falls under the risk factor category that can be changeable/modifiable. This will also initiates other risk factors to come in lime light. Smoking will increases the risk of coronary atherosclerosis in men and women, irrespective of all ages. Smoking increases the risk of thrombosis (Blood clot formed inside a blood vessel, obstructing the flow of blood through the circulatory system), plaque rupture (Atheroma becomes vulnerable when the growth is rapid and it creates a thin cover that separates from the bloodstream inside the arterial lumen.), myocardial infarction (Heart Attack), Arrhythmias (heartbeat is irregular, too fast, or too slow.) And sudden death.
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Adequacy of Cancer Screening in Adult Women with Congenital Heart Disease

Adequacy of Cancer Screening in Adult Women with Congenital Heart Disease

This retrospective institutional review board approved study of women over 18 years of age was performed at a single ACHD center. Primary care for these individuals was pro- vided by several primary care practices including community centers, multispecialty practices, and academic centers. One hundred seventy five patients with ACHD seen in the cardi- ology practice were consecutively selected between 2009 and 2011. Individuals with isolated patent foramen ovale, mitral valve prolapse, or isolated bicuspid aortic valve were excluded from the ACHD cohort. One hundred ACHD patients had adequate medical record data for analysis. Data regarding medical history, sexual history, pap smears, colonoscopy, and mammography were obtained from patient medical records, either from the electronic medical record or from primary care physicians’ faxed documentation.
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Prevalence of cardiovascular disease among Bangladeshi adult population: a systematic review and meta-analysis of the studies

Prevalence of cardiovascular disease among Bangladeshi adult population: a systematic review and meta-analysis of the studies

reported for stroke. The observed overall pooled prevalence of CVD regardless of the type of CVD was 5% in Bangladesh. Differences in the prevalence in different types of CVD are mainly due to the nature of each CVD type. The observed weighted pooled prevalence of CHD and congenital heart disease was quite similar. There can be few reasons for the relatively low stroke prevalence. The short duration of stroke illness, its low incidence, the challenges associated with the diagnosis of stroke that are mainly due to the cost and avail- ability of tests (eg, computed tomography [CT] scans and magnetic resonance imaging [MRI], which are expensive and not available in most rural areas) and low survival after an acute event (due to lack of proper treatment facilities, particularly in rural areas) can potentially be attributed to the low prevalence of stroke in Bangladesh. Conversely, a high prevalence of heart disease was observed. Although such a high prevalence of heart disease is based on only two studies, we could not identify potential causes for that. The defini- tion of heart disease was absent in one study, while several conditions were considered in defining heart disease in the other study. Including such conditions in the definition of heart disease can potentially inflate its prevalence.
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Prevalence and determinants of exclusive breastfeeding among lactating mothers in an urban slum, West Tripura: a cross sectional study

Prevalence and determinants of exclusive breastfeeding among lactating mothers in an urban slum, West Tripura: a cross sectional study

This study has several limitations. The findings of our result may not be generalizable to all lactating mothers residing in Tripura as well as in India as the study was done only in an urban slum, the field practice area of Urban Health Training Centre of Department of Community Medicine, Agartala Government Medical College

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