Julie Chabaneix, Anne-Cecile Huby, Nathalie Terras, Sophie Cramaregas, Eric Dumas de la Roque, Loic Sentilhes, Xavier Iriart, Jean-Benoit Thambo, François Roubertie, Roxane Coueron, Antoine Benard, Pascal Amedro
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引用次数: 0
Abstract
Background: Early detection of critical congenital heart disease (CHD) is essential to prevent cardiovascular collapse and improve neonatal outcomes. While prenatal screening has advanced significantly in high-income countries, postnatal detection remains a safety net, particularly for left-sided lesions. Although pulse oximetry (PO) screening has been evaluated in several settings with high prenatal detection rates, the added value of combining it with systematic paediatric examination, and its impact on care pathways remains incompletely characterised in such contexts.
Objective: To evaluate the diagnostic performance and care pathway impact of PO screening-alone and combined with routine paediatric examination-for detecting critical CHD in a high-performing regional prenatal screening system.
Methods: The OXYNAT study was a prospective, population-based interventional cohort in 28 maternity hospitals in Nouvelle-Aquitaine, France. 19 639 newborns were enrolled. PO was performed between 6 and 24 hours of life, followed by routine paediatric examination. Critical cases with CHD were identified through active multisource surveillance and followed for 1 year (supplemental file 1, visual abstra).
Results: Among the 14 infants diagnosed postnatally with a critical CHD, one death occurred in relation to delayed diagnosis of truncus arteriosus. PO alone yielded a sensitivity of 53.8% and specificity of 99.2% for detecting critical CHD. The combined strategy with paediatric examination improved sensitivity to 92.9% while maintaining high specificity (97.7%). However, only 4 of 14 infants postnatally followed an optimal care trajectory. Delays were mainly due to misinterpretation of early signs, incomplete echocardiographic assessment and coordination gaps.
Conclusions: In a healthcare setting with high antenatal CHD detection, PO alone is insufficient. Integrating systematic paediatric examination significantly improves diagnostic performance.
期刊介绍：
Archives of Disease in Childhood is an international peer review journal that aims to keep paediatricians and others up to date with advances in the diagnosis and treatment of childhood diseases as well as advocacy issues such as child protection. It focuses on all aspects of child health and disease from the perinatal period (in the Fetal and Neonatal edition) through to adolescence. ADC includes original research reports, commentaries, reviews of clinical and policy issues, and evidence reports. Areas covered include: community child health, public health, epidemiology, acute paediatrics, advocacy, and ethics.
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