新生儿严重先天性心脏病的筛查桑才华课件.ppt

Parent’s Perspective Learning Objectives Recognize the need for screening for critical heart disease in neonates Review the past and current practice of screening for critical heart disease in neonates Discuss future possible screening strategies Fetal Circulation Transitional Circulation Circulatory changes include: Increase in systemic vascular resistance Decrease in pulmonary vascular resistance Increase in left atrial pressure Closure of ductus arteriosus foramen ovale Increase in left ventricular stroke volume Autonomic changes include: Hypersympathetic state Newborns with CHD Congenital Heart Disease affects 5-10/1000 LB the most common birth defect 4/1000 require Rx in the first year of life Newborns with CHD CHD has significant morbidity/mortality nearly 40% deaths from congenital anomalies majority of deaths occur among infants Newborns with CHD Timely recognition in NB period is critical prenatal diagnosis made in only 23% of pregnancies and only 11% of LB Failure to diagnose critical CHD Failure to diagnose critical CHD Newborns with CHD Newborns with CHD Pulse Oximetry Screening Pulse Oximetry as Screening Method Pulse oximetry measures the amount of oxygen in the blood Non-invasive and painless test Normal Adult Circulation Transitional Circulation Simple Transposition of the Great Arteries Interrupted Aortic Arch with VSD Hypoplastic Left Heart Syndrome Pulmonary Atresia Intact Septum Pulse Oximetry Screening Pulse Oximetry Screening Physical Exam + Pulse Oximetry Physical Exam + Pulse Oximetry Why have we not done anything? Cardiologists have not been supportive of screening. Advocacy necessary. AHA/AAP Scientific Statement Purpose: address evidence on the routine use of pulse oximetry in newborns to detect critical CHD Medline database searches from 1966-2008 Utilized AHA classification of recommendations and levels of evidence for practice guidelines Analysis of pooled studies performed after 24 h life Sensitivity 69.6%, PPV 47% F