Improving diagnostic accuracy in the transport of infants with suspected duct‐dependent congenital heart disease. (6th October 2013)

• Record Type: Journal Article
• Authors: Gupta, Neelam; Kamlin, C Omar; Cheung, Michael; Stewart, Michael; Patel, Neil
• Is Part Of: Journal of paediatrics and child health. Volume 50:Number 1(2014:Jan.)
• Page Start: 64
• Page End: 70
• Publication Date: 2013-10-06
• Subjects: Children -- Health and hygiene -- Periodicals; Pediatrics -- Periodicals; 618.92
• DOI: 10.1111/jpc.12410
• Languages: English
• ISSNs: 1034-4810

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jpc12410-sec-5001" sec-type="section"> <title>Aim</title> <p>To identify factors that distinguish duct‐dependent congenital heart disease (DDCHD) from non‐DDCHD in newborn infants.</p> </sec> <sec id="jpc12410-sec-5002" sec-type="section"> <title>Method</title> <p>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.</p> </sec> <sec id="jpc12410-sec-5003" sec-type="section"> <title>Results</title> <p>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 SpO<sub>2</sub> of <92%, PaO<sub>2</sub> <50 mmHg, and pre‐post ductal SpO<sub>2</sub> difference >10% were significantly associated with DDHCD on univariate analysis. No single clinical finding was significantly associated with DDCHD on multivariate analysis. Labile SpO<sub>2</sub>, abnormal lung parenchyma, mean BP <40 mmHg, pH <7.25, lactate >5 and FiO<sub>2</sub> >0.5 were significantly associated with non‐DDCHD, but at multivariate analysis only labile SpO<sub>2</sub> and mean BP <40 mmHg were associated with non‐DDCHD.</p> </sec> <sec id="jpc12410-sec-5004" sec-type="section"> <title>Conclusions</title> <p>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.</p> </sec> </abstract>