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Improving diagnostic accuracy in the transport of infants with suspected duct-dependent congenital heart disease

Authors

  • Neelam Gupta,

    Corresponding author
    1. Newborn Emergency Transport Services, Royal Children's Hospital, Melbourne, Victoria, Australia
    2. Neonatal Unit, John Radcliffe Hospital, Oxford, United Kingdom
    • Correspondence: Dr Neelam Gupta, Neonatal Unit, Level 2, Women's Centre, John Radcliffe Hospital, Oxford OX39DU, UK. Fax: (+44) 2380 798 522; email: neelam27@doctors.org.uk

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  • C Omar Kamlin,

    1. Newborn Emergency Transport Services, Royal Children's Hospital, Melbourne, Victoria, Australia
    2. Newborn Research, Royal Women's Hospital, Melbourne, Victoria, Australia
    3. Neonatal Research, The University of Melbourne, Melbourne, Victoria, Australia
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  • Michael Cheung,

    1. Department of Cardiology, Royal Children's Hospital, Melbourne, Victoria, Australia
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  • Michael Stewart,

    1. Newborn Emergency Transport Services, Royal Children's Hospital, Melbourne, Victoria, Australia
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  • Neil Patel

    1. Neonatal Service, Royal Children's Hospital, Melbourne, Victoria, Australia
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  • Contributorship: All authors were responsible for planning and reporting. NG and NP conducted the data collection and analysis.
  • Funding: No funding provided/obtained for this study.
  • Conflict of interest: Nil.
  • Data sharing: No additional data.

Abstract

Aim

To identify factors that distinguish duct-dependent congenital heart disease (DDCHD) from non-DDCHD in newborn infants.

Method

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.

Results

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.

Conclusions

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.

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