The Effectiveness of Neonatal Screening for Critical Congenital Heart Defects by Dual-Zone Measurement of Systolic Blood Pressure and Saturation
Authors:   National Medical Research Center for Obsterics, Gynecology and Perinatology named after Academician V.I. Kulakov, Bokerija E.L. ,   Moscow, Russian Federation, Shumakova O.V. ,   I.M. Sechenov First Moscow State Medical University (Sechenov University); Moscow, Russian Federation, Karavaeva A.L. ,   National Medical Research Center for Obsterics, Gynecology and Perinatology named after Academician V.I. Kulakov; Moscow, Russian Federation, Timofeeva L.A. ,   National Medical Research Center for Obsterics, Gynecology and Perinatology named after Academician V.I. Kulakov; Moscow, Russian Federation, Makieva M.I. ,   National Medical Research Center for Obsterics, Gynecology and Perinatology named after Academician V.I. Kulakov; Moscow, Russian Federation, Zubkov V.V. ,   National Medical Research Center for Obsterics, Gynecology and Perinatology named after Academician V.I. Kulakov; Moscow, Russian Federation,   I.M. Sechenov First Moscow State Medical University (Sechenov University); Moscow, Russian Federation
Published: October 2024

Aim. To evaluate screening methods for critical congenital heart defects (CHD), in particular obstructive aortic arch defects (OАADs), using dual-zone systolic blood pressure (SBP) and oxygen saturation measurements in healthy newborns. Design. A prospective observational study. Material and methods. The study included 12 098 healthy newborns aged 48 (36–50) hours of life, who were screened for critical CHDs using dual-zone measurements of SBP and saturation, as well as using physical methods. Screening for critical CHDs was considered normal if the saturation difference was 2% or less, the saturation was more than 95%, the difference in SBP was 9 mm Hg and less. If the screening was abnormal, echocardiography (ECHO-CG) was performed. The end point of the study was to determine the sensitivity and specificity of screening for OPAADs in healthy newborns using dual-zone measurement of SBP and saturation. Results. 12 037 children had normal screening results. In these children, the difference in pre- and postductal SBP was 0 (standard deviation (σ) = 4.26 mm Hg, and the difference (Me) in saturation was 0 (σ = 0.93%). Dual-zone SBP screening was abnormal in 34 newborns. The difference in their SBP was 11 (10–34) mm Hg. In 16 of these children ECHO-CG did not reveal CHD, and in 4 — critical OAADs — coarctation of aorta was diagnosed. A decrease in peripheral pulsation in the femoral arteries was noted only in children with critical OAADs. Pulse oximetry screening was normal in these children with critical OAADs. Dual-zone saturation screening was abnormal in 16 children. The difference in saturation between them was 3 (3–5)%. In 13 of these children, ECHO-CG did not reveal CHDs, and in 1 child critical CHD was diagnosed — transposition of the great arteries. Also, this child (and another who was healthy) had a decrease in saturation of less than 95%. In 11 newborns, screening was abnormal only due to saturation of 95% or less, but ECHO-CG did not reveal CHDs. The sensitivity and specificity of screening for OAADs using dual-zone SBP measurement was 100 and 80%, and using dual-zone pulse oximetry was 0 and 73.6%, respectively. Conclusions. In newborns with OAADs, a difference in SBP of 10 mmHg is recorded after 36 hours of their life. Dual-zone measurement of SBP is the most highly sensitive and specific method for detecting OAADs in comparison with dual-zone pulse oximetry. Dual-zone measurement of SBP and determination of peripheral pulsation are recommended for inclusion in the neonatal screening protocol for critical CHDs. Keywords: congenital heart disease, neonatal screening for congenital heart defects, aortic coarctation, aortic arch interruption, blood pressure.