Background: A large proportion of neonates born with congenital heart disease (CHD) are missed at birth in Indian hospitals.
Objective: To examine the feasibility of development of a clinical strategy for detection of congenital heart disease (CHD) in the newborn through a combination of clinical signs and pulse oxymetry that best predicts the presence of CHD.
Methods: All consecutive newborns born in a secondary level hospital between June 2006 and June 2008 were prospectively screened for CHD 48 hours after birth. The on-site pediatrician did the clinical screening. A study nurse recorded pulse oxymetry. Echocardiography was performed on site in all newborns. A 6-week clinical follow-up evaluation was done for all.
Results and analysis: Of 4190 babies screened, 325 had CHD (prevalence: 7.7%). Nine (0.21%) had major CHD, two of whom (one ALCAPA and one large VSD) were missed during the initial evaluation; four of these had a normal clinical evaluation and only one had abnormal oxymetry. Univariate predictors of CHD included murmur, central cyanosis, precordial pulsation, and respiratory rate >60/minute. On multivariate analysis, murmur (OR=5.8; 95% C.I 3.44 -9.76) and respiratory rate >60/min (OR=2.54; 95% C.I 1.0 – 6.47) were associated with presence of CHD. Pulse oxymetry did not appear to contribute to the detection of CHD.
Conclusions: Clinical evaluation immediately after birth has a very low sensitivity for CHD detection in the newborns. Presence of murmur in a newborn warrants referral for echocardiography. A 6-week clinical evaluation is recommended to ensure that major CHD does not go undetected.