412 SCREENING FOR CONGENITAL HEART DISEASE IN THE NEWBORN NURSERY. (1st January 2005) - Barlow, R.
Abstract : Purpose: Congenital heart disease (CHD) occurs in 0.8% of live births. Diagnosis of CHD in the newborn often depends on subtle findings and physical examinations fail to detect more than half of newborns with CHD. One reason physicians fail to detect CHD might be the inability to identify cyanosis on routine examination. Pulse oximetry screening on all newborns would identify cyanosis prior to discharge and in conjunction with blood pressures help identify CHD before infants become symptomatic. Our purpose was to obtain pre- and postductal oxygen saturations and blood pressures in consecutive newborns to identify normal oxygenation values associated with pre- and postductal closure. These values in conjunction with simultaneous blood pressures will be used to increase our sensitivity for diagnosing CHD. Methods: All newborns admitted to the nursery had pre- and postductal blood pressures and pulse oximetry readings done when admitted and prior to discharge. Data were collected and analyzed for pre- and postductal as well as admission vs. discharge statistical significance using Bonferroni analysis with correction for multiple comparisons. Results: Preliminary data in 29 patients demonstrated a statistically significant difference between admission vs. discharge preductal systolic blood pressures (SBP) (p = .0004), admission vs. discharge postductal diastolic blood pressures (DBP) (p = .0001) and admission vs. discharge preductal DBP (p = .0003). Pre- and postductal oxygen saturations and postductal admission vs. discharge SBP were not statistically significant. Conclusions: The results in our study suggest important physiological changes occurring within the first several hours of life. These changes appear to be leading to an increased SBP and DBP to maintain perfusion throughout the body. The observed changes are probably associated with increased systemic vascular resistance as the ductus arteriosus closes and could also suggest why it may be difficult to identify congenital heart disease prior to discharge (within 48-72 hours). Comparison to infants with congenital heart disease may elicit more significant information related to oxygen saturations and blood pressures in screening for CHD and will be done as data become available, including a very large population of newborn infants for comparison.