Pulse Oximetry and Congenital Heart Disease in Newborns
Congenital heart disease (CHD) occurs in approximately 8 out of 1,000 live births (Centers for Disease Control and Prevention [CDC], 2012), and is responsible for almost 30% of infant deaths related to birth defects (CDC, 2013b). Of those children with CHD, 25% will have critical congenital heart disease (CCHD) – defined as needing catheter intervention or surgery within the first year of life (CDC, 2012; CDC, 2013a). Although the number of deaths associated with missed or delayed CCHD diagnosis varies greatly in the literature, the possible morbidity and mortality provide sufficient edification for the need for early detection and intervention.
In the first days and weeks of life, newborns with undiagnosed CCHD are at risk for sudden deterioration in clinical status due to changes in pulmonary vascular resistance and the closing of the ductus arteriosus, which is frequently needed for sustained pulmonary or systemic blood flow. This loss of oxygenated blood flow can lead to significant organ damage as a result of hemodynamic compromise, with arguably one of the most devastating consequences being brain injury due to ischemia. Therefore, intervention for diagnosed CCHD is usually done within the first couple weeks of life and may include prostaglandin infusions, transcatheter interventions, and surgery, all leading to significant improvement in CCHD survival rates (Boneva et al., 2001; Mahle et al., 2009).
Introduction
Congenital heart disease (CHD) occurs in approximately 8 out of 1,000 live births (Centers for Disease Control and Prevention [CDC], 2012), and is responsible for almost 30% of infant deaths related to birth defects (CDC, 2013b). Of those children with CHD, 25% will have critical congenital heart disease (CCHD) – defined as needing catheter intervention or surgery within the first year of life (CDC, 2012; CDC, 2013a). Although the number of deaths associated with missed or delayed CCHD diagnosis varies greatly in the literature, the possible morbidity and mortality provide sufficient edification for the need for early detection and intervention.
In the first days and weeks of life, newborns with undiagnosed CCHD are at risk for sudden deterioration in clinical status due to changes in pulmonary vascular resistance and the closing of the ductus arteriosus, which is frequently needed for sustained pulmonary or systemic blood flow. This loss of oxygenated blood flow can lead to significant organ damage as a result of hemodynamic compromise, with arguably one of the most devastating consequences being brain injury due to ischemia. Therefore, intervention for diagnosed CCHD is usually done within the first couple weeks of life and may include prostaglandin infusions, transcatheter interventions, and surgery, all leading to significant improvement in CCHD survival rates (Boneva et al., 2001; Mahle et al., 2009).