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Published on: April 7, 2023
Review Showed That Better Screening Is Still Needed for a Minority of Severe and Critical Congenital Heart Defects
1Association for Children With Congenital Heart Disease, Oslo, Norway.
Insights
Effective screening for severe congenital heart defects (CHDs) before hospital discharge is crucial. While prenatal ultrasounds, pulse oximetry (POX), and clinical exams improve detection, challenges remain in identifying all critical CHDs.
Area of Science:
- Neonatal care
- Pediatric cardiology
- Medical screening
Background:
- Congenital heart defects (CHDs) are a significant concern in neonates.
- Early detection of severe and critical CHDs before hospital discharge is vital for infant outcomes.
- Current screening methods include prenatal ultrasound, postnatal pulse oximetry (POX), and clinical examinations.
Purpose of the Study:
- To review the effectiveness of prenatal ultrasound, postnatal pulse oximetry (POX), and clinical examinations for detecting severe and critical congenital heart defects (CHDs) in neonates.
- To analyze detection rates and identify challenges in current screening strategies.
Main Methods:
- Systematic review of studies published between 2005 and 2025.
- Emphasis on studies from Nordic countries.
- Analysis of detection rates for different screening modalities.
Main Results:
- Prenatal detection rates for CHDs ranged from 42%-46%.
- Postnatal pulse oximetry (POX) detected 11%-47% of CHDs when prenatal cases were excluded.
- Clinical examinations identified 39%-58% of CHDs when POX-detected cases were excluded.
- Overall, 85%-89% of severe and critical CHDs were detected before discharge in infants born between 2014-20.
Conclusions:
- Most severe and critical CHDs are identified before neonates are discharged.
- Despite improvements, challenges persist in developing comprehensive screening methods to minimize missed cases.
- Further research is needed to enhance screening protocols for congenital heart defects.
Aim:
The review explored the effectiveness of different screening strategies for detecting severe and critical congenital heart defects (CHDs) before neonates were discharged from hospital after birth. These were prenatal fetal ultrasounds, postnatal pulse oximetry (POX), and clinical examinations.
Methods:
This paper references studies that were published from 2005 to 2025, with a particular emphasis on those from Nordic countries.
Results:
Prenatal detection rates of 42%-46% in live born infants were registered in nationwide studies. Pregnancy termination rates for severe or critical CHDs increased to 25%-43% and these influenced the prevalences and postnatal detection patterns of such defects. When CHDs that were detected prenatally were excluded, POX screening on the first day of life detected 11%-47% of severe and critical CHDs, depending on the inclusion criteria. When those detected by POX screening were excluded, routine clinical examinations identified 39%-58% of the cases in apparently healthy infants. The remainder were detected because of symptoms or some comorbidity. In infants born in 2014-20, 85%-89% of the severe and critical CHDs were found before discharge.
Conclusion:
Although most severe and critical CHDs were detected before discharge, there are still challenges with regard to developing better screening methods to reduce cases that have been missed.
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