Improving diagnostic accuracy in the transport of infants with suspected duct-dependent congenital heart disease

  • Gupta N
  • Kamlin C
  • Cheung M
 et al. 
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Abstract

AIM: To identify factors that distinguish duct-dependent congenital heart disease (DDCHD) from non-DDCHD in newborn infants.

METHOD: A retrospective, cohort study. The Newborn Emergency Transport Service, Victoria (NETS) is a retrieval service for all inter-hospital neonatal transfers, and the Royal Children's Hospital, Melbourne (RCH) is a paediatric cardiac referral centre for the state of Victoria, Australia. All infants ≤10 days and ≥34 weeks gestation with suspected CHD and/or persistent pulmonary hypertension of the newborn (PPHN), transferred by NETS from non-tertiary neonatal units to RCH, over a 4-year period.

RESULTS: Of 142 eligible infants, 81 had DDCHD and 61 had non-DDCHD, of whom 51 had PPHN. Diagnostic accuracy of DDCHD by the NETS team was 77%. Presence of a heart murmur, abnormal pulses, upper and lower limb blood pressure (BP) difference >10 mmHg, cardiomegaly, initial SpO2 of 10% were significantly associated with DDHCD on univariate analysis. No single clinical finding was significantly associated with DDCHD on multivariate analysis. Labile SpO2 , abnormal lung parenchyma, mean BP 5 and FiO2 >0.5 were significantly associated with non-DDCHD, but at multivariate analysis only labile SpO2 and mean BP
CONCLUSIONS: Clinical diagnosis of DDCHD outside of a cardiac centre is challenging. No single factor predicts DDCHD. Combined interpretation of clinical, physiological and x-ray findings may assist.

Author-supplied keywords

  • congenital heart disease
  • newborn infant
  • prostaglandin E1
  • transport

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