Congenital heart disease (CHD) is one of the commonest congenital malformations that are mostly asymptomatic at birth, which challenges the diagnosis of neonatal CHD. An early accurate prenatal diagnosis will give parents a choice, as well as the opportunity to plan the delivery and improve the postnatal outcome. The purpose of the study is to evaluate the value of heart murmurs, SpO2 abnormalities, tachypnea, and extracardiac malformations in screening neonatal CHD. All 4500 newborns in the obstetrics department of our hospital from January 2019 to January 2020 are selected as study subjects. Newborns were grouped according with the presence of heart murmurs, tachypnea, transdermal
Congenital heart disease (CHD) is a congenital malformation caused by the abnormal development of the heart and large blood vessels during the fetal period, which seriously endangers the lives and quality of life of children [
The growth of the lungs in the first year after birth includes the development of new alveoli and pulmonary blood vessels, which reduces the pressure and flow of the pulmonary circulation to normal, so that the pulmonary vascular system will recover in the first year after birth. It can transform and develop normally.
The most serious sequela of children with critically ill CHD are hypoxic-ischemic brain damage and structural defects [
The risk of the first-stage surgery in the neonatal period is significantly less than the risk of not being able to perform the first-stage surgery in the later period. The risk of the initial palliative surgery plus the second-stage radical surgery is much higher.
Children with CHD are a huge family pressure. Parents always live in a place of great fear. Early radical treatment can enable parents to treat their children and live normally.
Early surgery can improve the quality of life of children, and the resources and costs required for staged surgery will greatly increase. Research data at home and abroad shows that for some complicated CHD, as well as early cases of severe cyanosis and cardiac insufficiency, if the diagnosis can be obtained in the neonatal period, it can provide more adequate opportunities and conditions for early intervention and give the necessary drug intervention and interventional therapy, or early surgical correction can significantly improve the prognosis of children and avoid death.
Recently, CHD screening has received an increasing attention. Some researchers focus on identification of molecular biomarkers for heart diseases [
All 4,500 newborns born in the Obstetrics Department of our hospital from January 2019 to January 2020 are initially enrolled into this retrospective study. Among these newborns, the male to female ratio is about 1.07 : 1, for 2326 and 2174 cases, respectively. The preterm to term newborn ratio is about 1.94 : 1, for 2970 and 1530 cases, respectively. The average gestational age at birth was
Newborns with heart murmurs, tachypnea, transdermal
Cardiac sonographers performed echocardiography examinations to confirm the diagnosis of CHD among these 4,500 newborns. Newborns was lying from a supine to lateral position and their long axis of the left ventricle, apical four chamber, short axis of great artery, and suprasternal fossa were screened by echocardiography (iE33, Philips Healthcare, Hamburg, Germany).
All 4,500 newborns were screened by trained and qualified pediatricians and child health doctor to evaluate the presence of heart murmur, tachypnea, abnormal SpO2, and extracardiac malformations. The child health doctor was responsible for transcutaneous oxygen saturation measurement, and the pediatrician was responsible for cardiac auscultation to ensure that the results of transcutaneous oxygen saturation measurement are accurate. Newborns with grade II at cardiac auscultation was considered positive for heart murmur [
All data were processed by the SPSS 23.0 software. The counting data were described by ratio or percentage and analyzed by the chi-square test. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the diagnostic value. A level of
Among 4,500 newborns, 517 newborns were positive for heart murmur, tachypnea, abnormal SpO2, and/or extracardiac malformations. The positive rate was 11.5%. Among 517 newborns, there were 275 female newborns and 242 male newborns. Female newborns (275/2,174) showed a higher positive rate than male newborns (242/2,326). The difference was statistically significant (
Types of 65 cases of CHD.
Type | Number (%) |
---|---|
Ventricular septal defect | 18 (27.7%) |
Atrial septal defect ( | 12 (18.5%) |
Patent ductus arteriosus | 8 (12.3%) |
Pulmonary valve stenosis | 8 (12.3%) |
Atrioventricular septal defect | 4 (6.2%) |
Tricuspid atresia with ventricular septal defect | 4 (6.2%) |
Right ventricular double outlet | 2 (3.1%) |
Aortic stenosis | 2 (3.1%) |
Coarctation of the aorta | 2 (3.1%) |
Complete ectopic pulmonary venous drainage | 3 (4.6%) |
Mitral valve atresia | 1 (1.5%) |
The month old of included newborns and positive rates for heart murmur, tachypnea, abnormal SpO2, and/or extracardiac malformations.
Age (month) | Total number | Positive number | Detection rate (%) |
---|---|---|---|
0–3 | 1980 | 42 | 2.1 |
4–6 | 1640 | 17 | 1.0 |
7–12 | 880 | 6 | 0.7 |
Total | 4500 | 65 | 1.4 |
Heart murmur, tachypnea, abnormal SpO2, or extracardiac malformations were separately used to diagnose CHD. As shown in Table
Diagnostic performance of heart murmur, tachypnea, abnormal SpO2, or extracardiac malformations alone for CHD.
Index | Murmur group | Tachypnea group | Abnormal SpO2 group | Extracardiac malformation group |
---|---|---|---|---|
Sensitivity (%) | 40.32 | 31.25 | 51.26 | 30.68 |
Specificity (%) | 47.36 | 78.98 | 82.65 | 54.23 |
Youden’s index | 0.21 | 0.15 | 0.36 | 0.13 |
The AUC when heart murmur, tachypnea, abnormal SpO2, or extracardiac malformations were separately used to diagnose CHD.
Newborns positive for heart murmur, tachypnea, and abnormal SpO2 are classified into group A. Newborns positive for murmur, tachypnea, and extracardiac malformations are classified into group B. Newborns positive for murmurs, abnormal SpO2, and extracardiac malformations are classified into group C. Newborns positive for SpO2, tachypnea, and extracardiac malformations are classified into group D. Newborns positive for four indicators are classified into group E. Heart murmur, tachypnea, abnormal SpO2, and extracardiac malformations in combination were used to diagnose CHD. As shown in Table
Diagnostic performance of heart murmur, tachypnea, abnormal SpO2, and extracardiac malformations in combination for CHD.
Index | A group | B group | C group | D group | E group |
---|---|---|---|---|---|
Sensitivity (%) | 71.6 | 55.6 | 62.39 | 68.65 | 91.23 |
Specificity (%) | 89.65 | 91.23 | 89.65 | 94.68 | 95.26 |
Youden’s index | 0.57 | 0.71 | 0.75 | 0.65 | 0.91 |
The AUC when heart murmur, tachypnea, abnormal SpO2, and extracardiac malformations were used in combination to diagnose CHD. Newborns positive for heart murmur, tachypnea, and abnormal SpO2 are classified into group A. Newborns positive for murmur, tachypnea, and extracardiac malformations are classified into group B. Newborns positive for murmurs, abnormal SpO2, and extracardiac malformations are classified into group C. Newborns positive for SpO2, tachypnea, and extracardiac malformations are classified into group D. Newborns positive for four indicators are classified into group E.
Due to the particularity of childhood diseases in growth and development, some cases with mild CHD can heal naturally during the growth and development process. Follow-up was performed on 65 confirmed cases of cardiac color Doppler ultrasound after 3 months (Table
Follow-up data after 3 months.
CHD classification | Neonatal period | After 3 months | Self-healing rate |
---|---|---|---|
Ventricular septal defect | 18 | 14 | 22.2% |
Atrial septal defect | 12 | 9 | 25.0% |
Patent ductus arteriosus | 8 | 5 | 37.5% |
Others | 27 | 21 | 22.2% |
CHD is a cardiovascular malformation caused by the abnormal development of the heart and blood vessels in the fetus. It is the most common heart disease in children. Foreign literature reports that the incidence of CHD is 9/1,000, most of which are mild or moderate CHD, do not require treatment, or only need post infant treatment [
According to past experience, the diagnosis of critically ill congenital heart disease is mainly completed by prenatal ultrasound diagnosis and postnatal newborn physical examination, which makes up to 30% of infants not diagnosed with critically ill congenital heart disease before discharge from the hospital [
The test results showed that 4,500 newborns were screened by color echocardiography to identify 65 children with CHD and the preliminary statistics of the incidence of CHD were 1.4%. When murmur, tachypnea, abnormal SpO2, and extracardiac malformation were independently used to diagnose CHD, the sensitivity ranged from 30.68% to 51.26%, with specificity ranging from 47.36% to 82.65% and Youden’s index (YI) ranging from 0.13 to 0.36. Compared with the individual screening index, the related evaluation of the mixed group is relatively ideal, with a sensitivity of 89.36 and a specificity of 90.36%. When murmur, tachypnea, abnormal SpO2, extracardiac malformation were together used to diagnose CHD, 91.23% sensitivity, 95.26 specificity, and 0.91 YI were observed, suggesting that the use of the four mixed indicators for screening has better curative effects and is worthy of clinical promotion.
Due to the particularity of childhood diseases in growth and development, some mild congenital heart diseases can heal naturally during the growth and development process. Follow-up on confirmed cases of cardiac color Doppler ultrasound after 3 months was done. Among them, there were 18 patients with ventricular septal defect in the neonatal period and 4 patients healed themselves after 3 months, with a self-healing rate of 22.2%; of the 18 patients with atrial septal defect, 3 cases of atrial septal defect did not detect the shunt again, indicating that atrial septal defect healed spontaneously, with a self-healing rate of 25.0%; 8 patients with patent ductus arteriosus were detected, of which 3 were self-healing with a cure rate of 37.5% and the self-healing rate of other types of patients was 22.2%.
The above data show that the combined screening of 4 indicators including murmur, SpO2 abnormality, tachypnea, and extracardiac malformations has better results and is worthy of clinical promotion.
The data used to support the findings of this study are included within the article.
All authors declare that they have no conflict of interest.
Kai Chen and Jiao Wang contributed equally to this work.