Early detection of significant congenital heart disease: The contribution of fetal cardiac ultrasound and newborn pulse oximetry screening

Abstract

Fetal cardiac and newborn pulse oximetry screening has greatly facilitated the detection of cardiac abnormalities, which may be serious with potentially dire neonatal consequences. The prenatal diagnosis of a serious cardiac abnormality allows the attending obstetrician to organise the much safer in‐utero transfer of the fetus for delivery at a tertiary centre, particularly if there is evidence of a duct‐dependent lesion that may require the infusion of Prostaglandin E1 to maintain duct patency pending surgical intervention. Newborn pulse oximetry alerts the paediatrician that the baby may have a significant cardiac abnormality, which warrants further elucidation prior to discharge, rather than for the baby to represent unwell a few days later. Despite these advances, serious cardiac abnormalities may be missed on screening. Their detection then falls back onto the clinical acumen of the attending paediatrician/family physician to review the history, carefully elicit and evaluate the clinical signs further aided by whatever investigations that may be available at the birthing hospital, frequently less resourced than the tertiary centres. At the outset, a brief synopsis is provided of the clinical findings that may point to a cardiac abnormality. That is followed by a critical review of the accuracy of prenatal and newborn pulse oximetry screening with emphasis on the lesions that may be missed. Suggestions are made as to how to improve the diagnostic accuracy.

Preoperative Hemoglobin Level, Oxygen Saturation and Postoperative Outcomes in Children With Cyanotic Congenital Heart Disease: A Propensity-Score Matching Analysis

“…Compared to the entire population with a median age of 24.7 months, the median age was younger in children with PDA (13.5 months) or transposition of great arteries (10.3 months) and was older in children with aortopulmonary collateral arteries (31.8 months) or clubbed fingers or toes (48.9 months). Children with transposition of great arteries or duct-dependent CHD usually require early diagnosis and intervention (24,25) and may not have enough time to compensate for hemoglobin. In contrast, the presence of aortopulmonary collateral arteries and clubbed fingers and toes generally indicates that hypoxemia has existed for a long time.…”

The management of newborns with critical congenital heart diseases prior to transport to a cardiac center

“…The surveillance of newborn with CCHD starts by reviewing the maternal medical history for risk factors for congenital heart diseases and reviewing the fetal ultrasound or fetal echocardiogram. Physical examination is paramount in the initial admission to the nursery and prior to the discharge with emphasis on cyanosis, tachypnea, murmur, and palpable femoral pulse [6]. The physical examination of newborn with CCHD may not reveal clear abnormality due to transition from fetal circulation with elevated pulmonary vascular resistance (PVR) and the presence of the patent ductus arteriosus (PDA).…”

A Novel Framework for Abnormal Risk Classification over Fetal Nuchal Translucency Using Adaptive Stochastic Gradient Descent Algorithm

“…The fundamental contribution of this paper is the introduction of a completely automated technique to prenatal hydrocephalus identification based on significant textural aspects, intending to assess its ability to evaluate aberrant patients in less time. A short description of the clinical signs that may hint at a heart problem is presented in [ 34 ]. Following that, a critical examination of the efficiency of prenatal and neonatal pulse oximetry analysis is conducted, with a focus on lesions that may be overlooked.…”