AJP Reports最新文献

{"title":"Ethnic Disparities in Coronavirus Disease 2019 after the Implementation of Universal Screening in Hartford, Connecticut.","authors":"Veronica Maria Pimentel,&nbsp;Frank Ian Jackson,&nbsp;Anthony Dino Ferrante,&nbsp;Reinaldo Figueroa","doi":"10.1055/s-0041-1740562","DOIUrl":"https://doi.org/10.1055/s-0041-1740562","url":null,"abstract":"<p><p><b>Objective</b>  The aim of this article was to estimate the prevalence of coronavirus disease 2019 (COVID-19) in Connecticut, examine racial/ethnic disparities, and assess pregnancy outcomes in pregnant women following the implementation of universal screening for the virus. <b>Materials and methods</b>  This is a retrospective cohort study of all obstetric patients admitted to our labor and delivery unit during the first 4 weeks of implementation of universal screening of COVID-19. Viral studies were performed in all neonates born to mothers with severe acute respiratory syndrome coronavirus 2. We calculated the prevalence of COVID-19, compared the baseline characteristics and pregnancy outcomes between those who tested positive and negative for the virus, and determined the factors associated with COVID-19. <b>Results</b>  A total of 10 (4.6%) of 220 women screened positive for the virus. All were asymptomatic. Week 1 had the highest prevalence of infection, nearing 8%. No neonates were infected. Hispanics were more likely to test positive (odds ratio: 10.23; confidence interval: [2.71-49.1], <i>p</i>  = 0.001). Obstetric and neonatal outcomes were similar between the groups ( <i>p</i>  > 0.05). <b>Conclusion</b>  Although the rate of asymptomatic COVID-19 was low, ethnic disparities were present with Hispanics being more likely to have the infection. <b>Key Points</b> 4.6% of pregnant women in labor and delivery tested positive for COVID-19 while being asymptomatic.Hispanic women were more likely to test positive for severe acute respiratory syndrome coronavirus 2.Pregnancy outcomes were similar between COVID-19 positive and negative women.No vertical transmission was detected.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"11 4","pages":"e147-e153"},"PeriodicalIF":0.9,"publicationDate":"2021-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a9/9e/10-1055-s-0041-1740562.PMC8695059.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39648647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated with Meeting Obstetric Care Consensus Guidelines for Nulliparous, Term, Singleton, Vertex Cesarean Births.","authors":"Tiffany Wang, Inga Brown, Jim Huang, Tetsuya Kawakita, Michael Moxley","doi":"10.1055/s-0041-1740563","DOIUrl":"10.1055/s-0041-1740563","url":null,"abstract":"<p><p><b>Objective</b>  This study aimed to identify factors associated with meeting the Obstetric Care Consensus (OCC) guidelines for nulliparous, term, singleton, and vertex (NTSV) cesarean births. <b>Materials and methods</b>  This was a retrospective case control study of women with NTSV cesarean births between January 2014 and December 2017 at single tertiary care center. Demographics and clinical characteristics were compared between women with NTSV cesarean births which did or did not meet OCC guidelines. A multivariable logistic regression model was used to evaluate the effect of each variable on the odds of meeting OCC guidelines. <b>Results</b>  There were 1,834 women with NTSV cesarean births of which 744 (40.6%) met OCC guidelines for delivery and 1,090 (59.4%) did not. After controlling for confounding factors, the odds of meeting OCC guidelines were increased for in-house providers managing with residents (adjusted odds ratio [aOR] = 2.03, 95% confidence interval [CI]: 1.44-2.87) and without residents (aOR = 1.66, 95% CI: 1.30-2.12), compared with non-in-house providers managing without residents. There was no significant difference in the odds of meeting OCC guidelines for in-house providers managing with or without residents (aOR = 1.23, 95% CI: 0.84-1.79). <b>Conclusion</b>  After adjusting for confounding factors, in-house provider coverage, regardless of resident involvement, is associated with increased odds of NTSV cesarean births meeting OCC guidelines. <b>Key Points</b> Frequency of adherence to OCC guidelines for NTSV cesarean births was 40.6%.Neither patient demographics nor comorbidities was associated with the odds of meeting OCC guidelines.In-house providers are associated with increased odds of meeting OCC guidelines.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"11 4","pages":"e142-e146"},"PeriodicalIF":0.9,"publicationDate":"2021-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/19/82/10-1055-s-0041-1740563.PMC8674087.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39601168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conservative Management of Presumed Fetal Anemia Secondary to Maternal Chemotherapy for Acute Myeloid Leukemia.","authors":"Christina M Nowik, Alina S Gerrie, Jonathan Wong","doi":"10.1055/s-0041-1740561","DOIUrl":"10.1055/s-0041-1740561","url":null,"abstract":"<p><p>Acute myeloid leukemia occurs rarely during pregnancy. When it is diagnosed remote from term, treatment in the form of daunorubicin plus cytarabine induction with consolidative cytarabine is typically undertaken after the first trimester. There is little data to guide fetal monitoring, in particular, whether and how often middle cerebral artery peak systolic velocity (MCA PSV) should be measured to screen for fetal anemia. Cytarabine may be particularly myelosuppressive to the fetus, but information pertaining to the management of this complication is also lacking in published literature. To our knowledge, we present the first case of presumed severe fetal anemia related to in utero exposure to chemotherapy that was managed conservatively with close sonographic monitoring, including serial measurement of MCA PSV. This case suggests that in the absence of hydrops fetalis or other signs of fetal decompensation, expectant management with ultrasound twice weekly, including MCA PSV, is appropriate. Ultrasounds may be decreased to weekly when MCA PSV does not suggest fetal anemia. Screening for fetal anemia can provide helpful information to guide the timing of chemotherapy administration and delivery. <b>Key Points</b> Chemotherapy for acute myeloid leukemia can cause fetal anemia.Fetal MCA PSV can be used to safely and effectively screen for fetal anemia.Observation of fetal anemia due to chemotherapy is reasonable, in the absence of hydrops.Monitoring of fetal MCA PSV can help guide timing of chemotherapy and delivery.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"11 4","pages":"e137-e141"},"PeriodicalIF":0.8,"publicationDate":"2021-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f2/55/10-1055-s-0041-1740561.PMC8674095.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39601167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Implications of Second and Third Trimester Surveillance Ultrasounds of Growth-Restricted Fetuses.","authors":"Amanda M Craig,&nbsp;Karampreet Kaur,&nbsp;Sarah A Heerboth,&nbsp;Heidi Chen,&nbsp;Chelsea J Lauderdale,&nbsp;Chevis Shannon,&nbsp;Lisa C Zuckerwise","doi":"10.1055/s-0041-1740170","DOIUrl":"https://doi.org/10.1055/s-0041-1740170","url":null,"abstract":"<p><p><b>Objective</b>  We sought to investigate the positive predictive value of ultrasound-diagnosed fetal growth restriction (FGR) for estimating small for gestational age (SGA) at birth. Secondary objectives were to describe clinical interventions performed as a result of FGR diagnosis. <b>Study Design</b>  This was a retrospective cohort of pregnancies diagnosed with FGR over 3 years at a single institution. Maternal demographics, antenatal and delivery data, and neonatal data were collected. Descriptive statistics and linear regression were conducted. <b>Results</b>  We included 406 pregnancies with diagnosis of FGR in second or third trimester. Median birth weight percentile was 17 (interquartile range: 5-50) and only 35.0% of these fetuses were SGA at birth. The positive predictive value of a final growth ultrasound below the 10th percentile for SGA at birth was 56.9%. Patients averaged eight additional growth ultrasounds following FGR diagnosis. One hundred and fourteen (28.1%) received antenatal steroids prior to delivery, and 100% of those delivered after more than 7 days following administration. There were 6 fetal deaths and 14 neonatal deaths. <b>Conclusion</b>  In the majority of cases, pregnancies diagnosed with FGR during screening ultrasounds resulted in normally grown neonates and term deliveries. These patients may be receiving unnecessary ultrasounds and premature courses of corticosteroids.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"11 4","pages":"e132-e136"},"PeriodicalIF":0.9,"publicationDate":"2021-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a5/11/10-1055-s-0041-1740170.PMC8610751.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39933351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurally Adjusted Ventilatory Assist in Very Prematurely Born Infants with Evolving/Established Bronchopulmonary Dysplasia.","authors":"Sandeep Shetty,&nbsp;Katie Evans,&nbsp;Peter Cornuaud,&nbsp;Anay Kulkarni,&nbsp;Donovan Duffy,&nbsp;Anne Greenough","doi":"10.1055/s-0041-1739458","DOIUrl":"https://doi.org/10.1055/s-0041-1739458","url":null,"abstract":"<p><p><b>Background</b>  During neurally adjusted ventilatory assist (NAVA)/noninvasive (NIV) NAVA, a modified nasogastric feeding tube with electrodes monitors the electrical activity of the diaphragm (Edi). The Edi waveform determines the delivered pressure from the ventilator. <b>Objective</b>  Our objective was to determine whether NAVA/NIV-NAVA has advantages in infants with evolving/established bronchopulmonary dysplasia (BPD). <b>Methods</b>  Each infant who received NAVA/NIV-NAVA and conventional invasive and NIV was matched with two historical controls. Eighteen NAVA/NIV-NAVA infants' median gestational age, 25.3 (23.6-28.1) weeks, was compared with 36 historical controls' median gestational age 25.2 (23.1-29.1) weeks. <b>Results</b>  Infants on NAVA/NIV-NAVA had lower extubation failure rates (median: 0 [0-2] vs. 1 [0-6] <i>p</i>  = 0.002), shorter durations of invasive ventilation (median: 30.5, [1-90] vs. 40.5 [11-199] days, <i>p</i>  = 0.046), and total duration of invasive and NIV to the point of discharge to the local hospital (median: 80 [57-140] vs. 103.5 [60-246] days, <i>p</i>  = 0.026). The overall length of stay (LOS) was lower in NAVA/NIVNAVA group (111.5 [78-183] vs. 140 [82-266] days, <i>p</i>  = 0.019). There were no significant differences in BPD (17/18 [94%] vs. 32/36 [89%] <i>p</i>  = 0.511) or home oxygen rates (14/18 [78%] vs. 23/36 [64%] <i>p</i>  = 0.305). <b>Conclusion</b>  The combination of NAVA/NIV-NAVA compared with conventional invasive and NIV modes may be advantageous for preterm infants with evolving/established BPD.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"11 4","pages":"e127-e131"},"PeriodicalIF":0.9,"publicationDate":"2021-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b4/9e/10-1055-s-0041-1739458.PMC8608553.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39933350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complete Molar Pregnancies with a Coexisting Fetus: Pregnancy Outcomes and Review of Literature.","authors":"Roxanna A Irani,&nbsp;Kerry Holliman,&nbsp;Michelle Debbink,&nbsp;Lori Day,&nbsp;Krista Mehlhaff,&nbsp;Lisa Gill,&nbsp;Cara Heuser,&nbsp;Alisa Kachikis,&nbsp;Kristine Strickland,&nbsp;Justin Tureson,&nbsp;Jessica Shank,&nbsp;Rachel Pilliod,&nbsp;Chitra Iyer,&nbsp;Christina S Han","doi":"10.1055/a-1678-3563","DOIUrl":"https://doi.org/10.1055/a-1678-3563","url":null,"abstract":"<p><p><b>Objective</b>  The objective of the study was to review the obstetric outcomes of complete hydatidiform molar pregnancies with a coexisting fetus (CHMCF), a rare clinical entity that is not well described. <b>Materials and Methods</b>  We performed a retrospective case series with pathology-confirmed HMCF. The cases were collected via solicitation through a private maternal-fetal medicine physician group on social media. Each contributing institution from across the United States ( <i>n</i>  = 9) obtained written informed consent from the patients directly, obtained institutional data transfer agreements as required, and transmitted the data using a Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant modality. Data collected included maternal, fetal/genetic, placental, and delivery characteristics. For descriptive analysis, continuous variables were reported as median with standard deviation and range. <b>Results</b>  Nine institutions contributed to the 14 cases collected. Nine (64%) cases of CHMCF were a product of assisted reproductive technology and one case was trizygotic. The median gestational age at diagnosis was 12 weeks and 2 days (9 weeks-19 weeks and 4 days), and over half were diagnosed in the first trimester. The median human chorionic gonadotropin (hCG) at diagnosis was 355,494 mIU/mL (49,770-700,486 mIU/mL). Placental mass size universally enlarged over the surveillance period. When invasive testing was performed, insufficient sample or no growth was noted in 40% of the sampled cases. Antenatal complications occurred in all delivered patients, with postpartum hemorrhage (71%) and hypertensive disorders of pregnancy (29%) being the most frequent outcomes. Delivery outcomes were variable. Four patients developed gestational trophoblastic neoplasia. <b>Conclusion</b>  This series is the largest report of obstetric outcomes for CHMCF to date and highlights the need to counsel patients about the severe maternal and fetal complications in continuing pregnancies, including progression to gestational trophoblastic neoplastic disease. <b>Key Points</b> CHMCF is a rare obstetric complication and may be associated with the use of assisted reproductive technology.Universally, patients with CHMCF who elected to manage expectantly developed antenatal complications.The risk of developing gestational trophoblastic neoplasia after CHMCF is high, and termination of the pregnancy did not decrease this risk.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"12 1","pages":"e96-e107"},"PeriodicalIF":0.9,"publicationDate":"2021-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/19/75/10-1055-a-1678-3563.PMC8843380.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39630547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respiratory and Gastrointestinal Management of an Infant with a Birth Weight of 258 Grams.","authors":"Ryo Itoshima,&nbsp;Arata Oda,&nbsp;Ryo Ogawa,&nbsp;Toshimitsu Yanagisawa,&nbsp;Takehiko Hiroma,&nbsp;Tomohiko Nakamura","doi":"10.1055/a-1678-3755","DOIUrl":"https://doi.org/10.1055/a-1678-3755","url":null,"abstract":"<p><p>Today, more infants weighing less than or equal to 300 g are born, and they survive because of the improvements in neonatal care and treatment. However, their detailed clinical course and neonatal intensive care unit management remain unknown due to their low survival rate and dearth of reports. A male infant was born at 24 weeks and 5 days of gestation and weighed 258 g. The infant received 72 days of invasive and 92 days of noninvasive respiratory support, including high-frequency oscillatory ventilation with volume guarantee and noninvasive neurally adjusted ventilatory assist. Meconium-related ileus was safely treated using diatrizoate. Although the infant was diagnosed with severe bronchopulmonary dysplasia and retinopathy of prematurity requiring laser photocoagulation, he had no other severe complications. He was discharged 201 days postdelivery (3 months of corrected age) with a weight of 3.396 kg. Although managing infants weighing less than or equal to 300 g is difficult, our experience shows that it is possible by combining traditional and modern management methods. The management of such infants requires an understanding of the expected difficulties and adaptation of existing methods to their management. The management techniques described here should help improve their survival and long-term prognosis.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"12 1","pages":"e89-e95"},"PeriodicalIF":0.9,"publicationDate":"2021-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ba/a5/10-1055-a-1678-3755.PMC8828450.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39915411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Less Invasive Surfactant Administration in Very Prematurely Born Infants.","authors":"Sandeep Shetty,&nbsp;Helen Egan,&nbsp;Peter Cornuaud,&nbsp;Anay Kulkarni,&nbsp;Donovan Duffy,&nbsp;Anne Greenough","doi":"10.1055/s-0041-1735632","DOIUrl":"https://doi.org/10.1055/s-0041-1735632","url":null,"abstract":"<p><p><b>Background</b>  Less invasive surfactant administration (LISA) is the preferred mode of surfactant administration for spontaneously breathing preterm babies supported by noninvasive ventilation (NIV). <b>Objective</b>  The aim of this study was to determine whether LISA on the neonatal unit or in the delivery suite was associated with reduced rates of bronchopulmonary dysplasia (BPD) or the need for intubation, or lower durations of invasive ventilation and length of hospital stay (LOS). <b>Methods</b>  A historical comparison was undertaken. Each \"LISA\" infant was matched with two infants (controls) who did not receive LISA. <b>Results</b>  The 25 LISA infants had similar gestational ages and birth weights to the 50 controls (28 [25.6-31.7] weeks vs. 28.5 [25.4-31.9] weeks, <i>p</i>  = 0.732; 1,120 (580-1,810) g vs. 1,070 [540-1,869] g, <i>p</i>  = 0.928), respectively. LISA infants had lower requirement for intubation (52 vs. 90%, <i>p</i>  < 0.001), shorter duration of invasive ventilation (median 1 [0-35] days vs. 6 [0-62] days <i>p</i>  = 0.001) and a lower incidence of BPD (36 vs. 64%, <i>p</i>  = 0.022). There were no significant differences in duration of NIV (median 26 [3-225] vs. 23 [2-85] days, <i>p</i>  = 0.831) or the total LOS (median 76 [24-259] vs. 85 [27-221], <i>p</i>  = 0.238). <b>Conclusion</b>  LISA on the neonatal unit or the delivery suite was associated with a lower BPD incidence, need for intubation, and duration of invasive ventilation.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"11 3","pages":"e119-e122"},"PeriodicalIF":0.9,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b5/32/10-1055-s-0041-1735632.PMC8458038.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10707478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Maternal Obesity Class, Adherence to Labor Guidelines, and Perinatal Outcomes.","authors":"Irene A Stafford, Ahmed S Z Moustafa, Lauren Spoo, Alexandra Berra, Angela Burgess, Mark Turrentine","doi":"10.1055/s-0041-1732409","DOIUrl":"10.1055/s-0041-1732409","url":null,"abstract":"<p><p><b>Background</b>  Data are limited concerning rates of perinatal complications in women with a body mass index (BMI) ≥40 kg/m2 compared to women with other BMI classes when guidelines for the safe prevention of the primary cesarean delivery are applied. <b>Objective</b>  The aim of the study is to evaluate labor guideline adherence by BMI class and to compare perinatal outcomes across BMI classes with guideline adherent management. <b>Study Design</b>  This retrospective study included low-risk women admitted for delivery between April 2014 and April 2017 after the labor guidelines were implemented. BMI closest to delivery was used for analysis. Women with cesarean for nonreassuring fetal status were excluded. <b>Results</b>  Guideline adherence decreased with increasing BMI, with 93% adherence among women of normal weight compared to 81% for class III obese women ( <i>p</i>  < 0.0001). Among women who had guideline-adherent management, there was increased rates of cesarean among class III versus other obesity classes; however, there were no differences in rates of infectious morbidity ( <i>p</i>  = 0.98) or hemorrhage ( <i>p</i>  = 0.93). Although newborns of women with class III obesity had higher rates of meconium at birth, neonatal outcomes were not different with increasing maternal BMI ( <i>p</i>  = 0.65). <b>Conclusion</b>  There were no differences in adverse perinatal outcomes with increasing BMI.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"11 2","pages":"e105-e112"},"PeriodicalIF":0.8,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/eb/ef/10-1055-s-0041-1732409.PMC8282364.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39195980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical Congenital Heart Disease Detection in the Screening Era: Do Not Neglect the Examination!","authors":"Deepika Sankaran,&nbsp;Heather Siefkes,&nbsp;Frank F Ing,&nbsp;Satyan Lakshminrusimha,&nbsp;Francis R Poulain","doi":"10.1055/s-0041-1727275","DOIUrl":"https://doi.org/10.1055/s-0041-1727275","url":null,"abstract":"<p><p>Pulse oximetry oxygen saturation (SpO ₂ )-based critical congenital heart disease (CCHD) screening is effective in detection of cyanotic heart lesions. We report a full-term male infant with normal perfusion who had passed the CCHD screening at approximately 24 hours after birth with preductal SpO ₂ of 99% and postductal SpO ₂ of 97%. Detection of a loud systolic cardiac murmur before discharge led to the diagnosis of pulmonary atresia (PA) with ventricular septal defect (PA-VSD) by echocardiogram. The infant was transferred to a tertiary care center after initiation of prostaglandin E1 (PGE1) therapy. Throughout the initial course, he was breathing comfortably without respiratory distress or desaturations on pulse oximetry. We believe that this is the first documented report of PA missed by CCHD screening. Thorough and serial clinical examinations of the newborn infant proved vital in the timely diagnosis of this critical disease. We review the hemodynamics and the recent literature evaluating utility of CCHD screening in the diagnosis of PA-VSD. Pulse oximetry-based CCHD screening should be considered a tool to enhance CCHD detection with an emphasis on detailed serial physical examinations in newborn infants.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"11 2","pages":"e84-e90"},"PeriodicalIF":0.9,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0041-1727275","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39250274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}