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Julien I E Hoffman
Now that pulse oximetry is used widely to screen for critical congenital heart disease, it is time to consider whether this screening method is applicable to those who live at high altitudes. Consideration of basic physical principles and reports from the literature indicate that not only is the 95 % cutoff point for arterial oxygen saturation incorrect at high altitudes, but the lower saturations are accompanied by greater variability and therefore there is the possibility of a greater percentage of false-positive screening tests at high altitudes...
June 2016: Pediatric Cardiology
Federico Schena, Irene Picciolli, Massimo Agosti, Antonio Alberto Zuppa, Gianvincenzo Zuccotti, Luciana Parola, Giulia Pomero, Giorgio Stival, Markus Markart, Silvia Graziani, Luigi Gagliardi, Cristina Bellan, Simona La Placa, Giuseppe Limoli, Gabriella Calzetti, Andrea Guala, Enza Bonello, Fabio Mosca
OBJECTIVE: To evaluate the efficacy of combined pulse oximetry (POX) and perfusion index (PI) neonatal screening for severe congenital heart defects (sCHD) and assess different impacts of screening in tertiary and nontertiary hospitals. STUDY DESIGN: A multicenter, prospective study in 10 tertiary and 6 nontertiary maternity hospitals. A total of 42 169 asymptomatic newborns from among 50 244 neonates were screened; exclusion criteria were antenatal sCHD diagnosis, postnatal clinically suspected sCHD, and neonatal intensive care unit admission...
April 2017: Journal of Pediatrics
William E Benitz
Despite a large body of basic science and clinical research and clinical experience with thousands of infants over nearly 6 decades,(1) there is still uncertainty and controversy about the significance, evaluation, and management of patent ductus arteriosus in preterm infants, resulting in substantial heterogeneity in clinical practice. The purpose of this clinical report is to summarize the evidence available to guide evaluation and treatment of preterm infants with prolonged ductal patency in the first few weeks after birth...
January 2016: Pediatrics
E M Goetz, K M Magnuson, J C Eickhoff, M A Porte, J S Hokanson
OBJECTIVE: Pulse oximetry screening (POS) is an effective tool to detect critical congenital heart disease (CCHD) in asymptomatic term infants, but its value in the neonatal intensive care unit (NICU) requires further clarification. STUDY DESIGN: A retrospective review of 1005 babies without previously diagnosed CCHD admitted to a level III NICU was performed to assess the risk for missed CCHD and performance of POS. RESULT: Of the 1005 NICU patients, 812 had documented POS and none failed POS...
January 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
N B Mathur, A Gupta, S Kurien
OBJECTIVE: To evaluate pulse oximetry for detection of congenital cyanotic heart disease in sick neonates using echocardiography as gold standard. METHODS: Pulse oximetry readings were taken at admission from 950 neonates from right upper limb and either foot with infant breathing room air. Pulse oximetry was considered abnormal if oxygen saturation at room air measured <90% or difference between right hand and foot was more than 3%. Persistent abnormality was considered positive result...
September 2015: Indian Pediatrics
C H Backes, H Huang, C L Cua, V Garg, C V Smith, H Yin, M Galantowicz, J A Bauer, T M Hoffman
OBJECTIVE: Delayed umbilical cord clamping (DCC) at birth may provide a better neonatal health status than early umbilical cord clamping (ECC). However, the safety and feasibility of DCC in infants with congenital heart disease (CHD) have not been tested. This was a pilot, randomized, controlled trial to establish the safety and feasibility of DCC in neonates with CHD. STUDY DESIGN: Pregnant women admitted >37 weeks gestational age with prenatal diagnosis of critical CHD were enrolled and randomized to ECC or DCC...
October 2015: Journal of Perinatology: Official Journal of the California Perinatal Association
Luis M Zabala, Nina A Guzzetta
Children with cyanotic congenital heart disease (CCHD) have complex alterations in their whole blood composition and coagulation profile due to long-standing hypoxemia. Secondary erythrocytosis is an associated physiological response intended to increase circulating red blood cells and oxygen carrying capacity. However, this response is frequently offset by an increase in whole blood viscosity that paradoxically reduces blood flow and tissue perfusion. In addition, the accompanying reduction in plasma volume leads to significant deficiencies in multiple coagulation proteins including platelets, fibrinogen and other clotting factors...
October 2015: Paediatric Anaesthesia
Joan Andrea
In recent years, pulse oximetry screening for critical congenital heart disease (CCHD) in newborns has been added to the list of recommended uniform screening panels and recommended by several health care organizations. Most states use pulse oximetry to screen for CCHD. Studies have identified problems with compliance and higher failure rate at moderate altitudes than at sea level, suggesting the need for alternate algorithms. Altitude, time, health status of newborns and type of cardiac defect appear to affect results...
August 2015: Nursing for Women's Health
Mary T Donofrio, Anita J Moon-Grady, Lisa K Hornberger, Joshua A Copel, Mark S Sklansky, Alfred Abuhamad, Bettina F Cuneo, James C Huhta, Richard A Jonas, Anita Krishnan, Stephanie Lacey, Wesley Lee, Erik C Michelfelder, Gwen R Rempel, Norman H Silverman, Thomas L Spray, Janette F Strasburger, Wayne Tworetzky, Jack Rychik
BACKGROUND: The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. METHODS AND RESULTS: A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options...
May 27, 2014: Circulation
Jeffrey A Feinstein, D Woodrow Benson, Anne M Dubin, Meryl S Cohen, Dawn M Maxey, William T Mahle, Elfriede Pahl, Juan Villafañe, Ami B Bhatt, Lynn F Peng, Beth Ann Johnson, Alison L Marsden, Curt J Daniels, Nancy A Rudd, Christopher A Caldarone, Kathleen A Mussatto, David L Morales, D Dunbar Ivy, J William Gaynor, James S Tweddell, Barbara J Deal, Anke K Furck, Geoffrey L Rosenthal, Richard G Ohye, Nancy S Ghanayem, John P Cheatham, Wayne Tworetzky, Gerard R Martin
In the recent era, no congenital heart defect has undergone a more dramatic change in diagnostic approach, management, and outcomes than hypoplastic left heart syndrome (HLHS). During this time, survival to the age of 5 years (including Fontan) has ranged from 50% to 69%, but current expectations are that 70% of newborns born today with HLHS may reach adulthood. Although the 3-stage treatment approach to HLHS is now well founded, there is significant variation among centers. In this white paper, we present the current state of the art in our understanding and treatment of HLHS during the stages of care: 1) pre-Stage I: fetal and neonatal assessment and management; 2) Stage I: perioperative care, interstage monitoring, and management strategies; 3) Stage II: surgeries; 4) Stage III: Fontan surgery; and 5) long-term follow-up...
January 3, 2012: Journal of the American College of Cardiology
Jack C Salerno, Stephen P Seslar
Supraventricular tachycardia is the most common rhythm disturbance in children. We reviewed the spectrum of this common rhythm disorder from symptom recognition and epidemiology to management, with special attention to advancements in the available treatment options.
March 2009: Archives of Pediatrics & Adolescent Medicine
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