Effects of universal critical CHD screening of neonates at a mid-sized California congenital cardiac surgery centre.
Miller R, Martens T, Jodhka U, Tran J, Lion R, Bock MJ.Cardiol Young. 2022 Feb;32(2):236-243. doi: 10.1017/S1047951121001797. Epub 2021 May 24.PMID: 34024296
Take Home Points:
- Universal neonatal cardiac oximetry screening has 38% sensitivity in diagnosing critical CHD
- Neonatal cardiac oximetry screening is most useful in diagnosing TAPVR
- Neonatal cardiac oximetry screening does not impact length of hospital stay, mortality or survival after surgery for CHD.
Commentary from Dr. Anna Tsirka (Hartford, CT, USA), section editor of Pediatric and Fetal Cardiology Journal Watch
Universal neonatal cardiac screening with pulse oximetry was implemented in California in July 2013.
This study seeks to evaluate the outcomes of newborns with CHD diagnosed prior to or at neonatal cardiac screen compared to those diagnosed after the screen at Loma Linda University Children’s Hospital between July 1st, 2013 and December 31st, 2018.
Included in the study were patients with CHD divided in two categories: the primary category was those with HLHS, PA-intact IVS, ToF, D- transposition, TAPVR, tricuspid atresia, and truncus arteriosus. Secondary lesions included all other single ventricles, coarctation of the aorta/ arch hypoplasia, Ebstein’s anomaly and DORV.
The primary endpoints were postoperative length of stay, operative mortality, absolute mortality and actuarial survival.
274 patients who underwent cardiac surgery before 1 year of age were included in the study. Of those, 46% were diagnosed prenatally, and another 33% were diagnosed clinically postnatally before screening was performed. 8% of patients were diagnosed by screening and 13% tested negative on screening and were diagnosed later. The sensitivity of cardiac screening to detect CHD among those undiagnosed till then was 38%.
Of those diagnosed by screening, 91% had one of the primary lesions. Of the undiagnosed primary lesions, 53% were diagnosed by screening, while only 10% of the undiagnosed secondary lesions were diagnosed by screening.
There was no difference in operative or absolute mortality or postoperative length of stay based on the timing of diagnosis.
The condition most commonly diagnosed was screening was TAPVR (73 %). A sub-analysis was performed comparing the outcomes of patients with TAPVR diagnosed after and before the implementation of screening, did not reveal differences in length of stay. There was no mortality in either era.
This is a very interesting retrospective review of the efficacy of the implementation of neonatal cardiac screening. It reveals that screening has only 38% sensitivity in diagnosis, and even in those who are diagnosed by screening, there was no impact on mortality/ survival or length of stay.
The study is limited in that it only evaluated patients who had surgery. It is possible that some infants may have died or suffered severe morbidity prior to surgery, and that mortality is not captured in this study.
In addition, in this study only 46% of patients were diagnosed prenatally. It is likely that the improving incidence of prenatal diagnosis of CHD limits the benefit of cardiac oximetry screening.
Based on this study, prenatal testing and clinical examination remain vital in diagnosing serious CHD.