Contributorship: All authors were responsible for planning and reporting. NG and NP conducted the data collection and analysis.
Improving diagnostic accuracy in the transport of infants with suspected duct-dependent congenital heart disease
Article first published online: 6 OCT 2013
© 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
Journal of Paediatrics and Child Health
Volume 50, Issue 1, pages 64–70, January 2014
How to Cite
Gupta, N., Kamlin, C. O., Cheung, M., Stewart, M. and Patel, N. (2014), Improving diagnostic accuracy in the transport of infants with suspected duct-dependent congenital heart disease. Journal of Paediatrics and Child Health, 50: 64–70. doi: 10.1111/jpc.12410
Funding: No funding provided/obtained for this study.
Conflict of interest: Nil.
Data sharing: No additional data.
- Issue published online: 7 JAN 2014
- Article first published online: 6 OCT 2013
- congenital heart disease;
- newborn infant;
- prostaglandin E1;
To identify factors that distinguish duct-dependent congenital heart disease (DDCHD) from non-DDCHD in newborn infants.
A retrospective, cohort study. The Newborn Emergency Transport Service, Victoria (NETS) is a retrieval service for all inter-hospital neonatal transfers, and the Royal Children's Hospital, Melbourne (RCH) is a paediatric cardiac referral centre for the state of Victoria, Australia. All infants ≤10 days and ≥34 weeks gestation with suspected CHD and/or persistent pulmonary hypertension of the newborn (PPHN), transferred by NETS from non-tertiary neonatal units to RCH, over a 4-year period.
Of 142 eligible infants, 81 had DDCHD and 61 had non-DDCHD, of whom 51 had PPHN. Diagnostic accuracy of DDCHD by the NETS team was 77%. Presence of a heart murmur, abnormal pulses, upper and lower limb blood pressure (BP) difference >10 mmHg, cardiomegaly, initial SpO2 of <92%, PaO2 <50 mmHg, and pre-post ductal SpO2 difference >10% were significantly associated with DDHCD on univariate analysis. No single clinical finding was significantly associated with DDCHD on multivariate analysis. Labile SpO2, abnormal lung parenchyma, mean BP <40 mmHg, pH <7.25, lactate >5 and FiO2 >0.5 were significantly associated with non-DDCHD, but at multivariate analysis only labile SpO2 and mean BP <40 mmHg were associated with non-DDCHD.
Clinical diagnosis of DDCHD outside of a cardiac centre is challenging. No single factor predicts DDCHD. Combined interpretation of clinical, physiological and x-ray findings may assist.