Identification of Critical Congenital Heart Disease in Vermont: The Role of Universal Pulse Oximetry Screening in a Rural State.
OBJECTIVE
Pulse oximetry screening (POS) is becoming the standard of care in screening for critical congenital heart disease (CCHD). Our objective was to characterize the historical diagnostic pattern in a rural tertiary care children's hospital and explore how universal POS might affect morbidity, mortality, and care delivery.


METHODS
We identified patients <6 months of age in the Vermont Children's Hospital echocardiogram database with CCHD diagnosed between 2002 and 2011. Charts were reviewed to characterize timing of diagnosis, course, and outcome. The medical examiner was consulted to identify deaths due to undetected CCHD during the study period.


RESULTS
Of 60 329 live births, 73 (0.12 %) were diagnosed with CCHD. Of these, 31 (42%) were diagnosed prenatally, 34 (47%) were diagnosed by clinical examination in the nursery, 7 (9.6%) were diagnosed after nursery discharge, and 1 (1.4%) was born at home. The 8 patients not diagnosed by prenatal ultrasound or in the nursery were considered cases of undetected CCHD. Three had normal oxygen saturation (>95%) at diagnosis. Three presented with cardiovascular compromise. None died and all were well at the most recent follow-up. Review of autopsy reports from patients <6 months found no deaths from undetected CCHD during the study period.


CONCLUSIONS
Over a 10-year period at our institution, universal POS could have identified 5 patients with undetected CCHD, possibly avoiding the need for resuscitation in 3. Examination of local diagnostic data may affect the cost/benefit considerations of universal POS initiatives in a setting of limited healthcare resources.
University of Vermont, Burlington, VT, USA ryanjgood@gmail.com.
Ryan J
RJ
Good
University of Vermont, Burlington, VT, USA.
Sarah K
SK
Canale
University of Vermont, Burlington, VT, USA.
Rebecca L
RL
Goodman
University of Vermont, Burlington, VT, USA.
Scott B
SB
Yeager
D016208:Databases, Factual; D006330:Heart Defects, Congenital / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010092:Oximetry; D011296:Prenatal Diagnosis; D012017:Referral and Consultation; D012189:Retrospective Studies; D019035:Rural Health Services; D014707:Vermont
congenital heart disease; newborn screening; pulse oximetry; rural health