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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Sensitivity of clinical assessment in term neonates by general pediatric residents
Aungkana Gengsakul1, Chalermkiet Tuntrakool, Suriporn Kunathai
1Cardiology Unit, Department of Pediatrics, Phramongkutklao Hospital, Bangkok, Thailand. gengsakul@yahoo.com
Insights
Pediatric residents can effectively detect congenital heart diseases through physical exams, with skilled physicians achieving high accuracy. Emphasizing cardiovascular examination training is crucial for early detection and cost-effective care.
Area of Science:
- Pediatrics
- Cardiology
- Medical Diagnostics
Background:
- Congenital heart diseases (CHDs) are a significant concern in newborns.
- Accurate early detection is vital for timely intervention and improved outcomes.
- The role of physical examination in diagnosing CHDs requires ongoing evaluation.
Purpose of the Study:
- To assess the accuracy of physical examination by pediatric residents in detecting congenital heart diseases.
- To identify risk factors associated with congenital heart diseases in term infants.
- To compare the diagnostic performance of physical examination with echocardiography.
Main Methods:
- A prospective study involving 500 term infants born between July 1999 and June 2000.
- Physical examinations were conducted by pediatric residents and pediatric cardiologists within the first week of life.
- Echocardiography was performed on all infants for definitive diagnosis, with results compared to physical exam findings.
Main Results:
- Congenital heart diseases were diagnosed in 3.6% of the infants.
- Physical examination by pediatric residents showed 39% sensitivity and 98% specificity.
- Pediatric cardiologists achieved 94% sensitivity and 97% specificity; Ventricular Septal Defect (VSD) and Patent Ductus Arteriosus (PDA) were most common.
Conclusions:
- Physical examination by skilled physicians is highly effective in detecting most congenital heart diseases.
- Echocardiography remains the gold standard for definitive diagnosis.
- Training general pediatricians in cardiovascular physical examination is recommended for cost-effective, early CHD detection.
Objectives:
To determine the accuracy of physical examination in detecting congenital heart diseases by pediatric residents and identify risk factors of congenital heart diseases.
Material And Method:
Five hundred term infants (GA > or = 37wks) who were born at Phramongkutklao Hospital from July 1st, 1999 to June 3th, 2000 were examined by pediatric residents and pediatric cardiologists within the first week of life. The echocardiography was performed in all 500 infants for definite diagnosis. The accuracy of physical examination was determined by comparing with echocardiographic finding and presented as sensitivity and specificity.
Results:
Congenital heart diseases were found in 18 of 500 term infants (3.6%). The physical examination by pediatric residents and pediatric cardiologists showeds a sensitivity of 39% and 94% and the specificity of 98% and 97%, respectively. After excluding spontaneously closed PDA within 2 weeks, the first and second most common congenital heart diseases in infants were Ventricular septum defect (VSD) (44%) and Patent ductus arteriosus (PDA) (33%). The positive other cardiovascular signs, such as cyanosis or abnormal pulses with heart murmur were significantly associated to diagnosis of congenital heart diseases.
Conclusion:
Although echocardiography is the major tool to determine the definite diagnosis, most congenital heart diseases can be well detected during physical examination by skilled physicians. As a result, the value of physical examination of the cardiovascular system should be emphasized in training general pediatricians concerning lower costs and early detection of congenital heart diseases.
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