Clinical application of neonatal screening test of pulse oxygen saturation at county, township and village level hospitals

doi:10.3877/cma.j.issn.1673-5250.2019.04.013

Objective

To explore the effectiveness and feasibility of early detection of neonatal infection and pulmonary disease by pulse oxygen saturation (SpO₂) screening at county, township and village level hospitals in western area of China with relatively short of resources.

Methods

A total of 15 720 newborns without obvious abnormal clinical manifestations from September 2015 to June 2017 who were born at 14 county and village level hospitals in Mianyang City, Sichuan Province such as People′s Hospital of Beichuan Qiang Autonomous County, Maternal and Child Health Hospital of Santai County, Maternal and Child Health Hospital of Youxian District, etc., were chosen as research subjects. At 12 h after birth, SpO₂ screening was implemented. The first screening result was negative, then the second screening would be done at 48 h after birth, on the contrary, then that second screening was not done. Newborns those who had positive screening results were transfered to Department of Neonatology, in order to clarify the presence of critical congenital heart disease by echocardiography. The causes of hypoxemia in neonates without critical congenital heart disease were further analyzed by clinical manifestations and laboratory examination results. This study was in line with World Medical Association Declaration of Helsinki revised in 2013, and informed contents were obtained from guardians of all participates.

Results

① Among 15 720 neonates of this study, a total of 34 cases had a positive screening results of SpO₂, positive rate of screening test of SpO₂ was 0.2%. ②Among 34 cases with screening positive results of SpO₂, there were critical congenital heart disease, neonatal pneumonia, neonatal sepsis, pneumothorax and wet lung of newborns of 6, 19, 5, 3 cases and 1 case, respectively. All 28 neonates with hypoxemia who were not caused by heart disease were immediately transferred to Department of Neonatology for timely and effective treatment, and all discharged from hospital after recovery.

Conclusions

In primary level hospitals, routine screening test of SpO₂ to newborns within 48 h after birth, may helpful for eraly find neonate with critical congenital heart disease and other causes of hypoxemia to take timely and effective treatment measures. Operation of neonatal screening test of SpO₂ is simple and its equipment cost is low. Clinical application of neonatal screening test of SpO₂ shows an advantage in primary level hospitals widely.

Key words: Oximetry, Neonatal screening, Anoxia, Congenital heart disease, Pneumonia, Infant, newborn

表1 本研究15 720例受试儿一般临床资料比较[例数(%)]

一般临床资料		构成比	一般临床资料		构成比
性别		?	民族		?
?	男	7 077(45.0)	?	汉族	14 512(92.3)
?	女	8 643(55.0)	?	羌族	1 208(7.7)
出生体重(g)		?	出生胎龄(周)		?
?	<2 500	478(3.0)	?	>35～40	12 740(81.0)
?	2 500～4 000	14 934(95.0)	?	>40	2 980(19.0)
?	>4 000	308(2.0)	?	?	?

表1 本研究15 720例受试儿一般临床资料比较[例数(%)]

一般临床资料		构成比	一般临床资料		构成比
性别		?	民族		?
?	男	7 077(45.0)	?	汉族	14 512(92.3)
?	女	8 643(55.0)	?	羌族	1 208(7.7)
出生体重(g)		?	出生胎龄(周)		?
?	<2 500	478(3.0)	?	>35～40	12 740(81.0)
?	2 500～4 000	14 934(95.0)	?	>40	2 980(19.0)
?	>4 000	308(2.0)	?	?	?

表2 本研究28例非心脏因素所致低氧血症的脉搏血氧饱和度筛查结果呈阳性患儿病例资料

编号	诊断	生后SpO₂筛查结果呈阳性的时间(h)	SpO₂(%，最小值～最大值)	超声心动图检查结果
患儿1	新生儿肺炎	12	88～92	动脉导管未闭
患儿2	新生儿肺炎	12	89～90	正常
患儿3	新生儿肺炎	12	92～94	正常
患儿4	新生儿肺炎	12	91～94	正常
患儿5	新生儿败血症	12	91～93	卵圆孔未闭
患儿6	新生儿气胸	12	93～94	动脉导管未闭
患儿7	新生儿肺炎	12	90～93	房间隔缺损(3 mm)
患儿8	新生儿肺炎	12	91～91	正常
患儿9	新生儿肺炎	12	87～89	卵圆孔未闭
患儿10	新生儿肺炎	12	84～86	正常
患儿11	新生儿肺炎	12	91～92	动脉导管未闭
患儿12	新生儿湿肺	12	90～93	正常
患儿13	新生儿败血症	12	88～90	动脉导管未闭
患儿14	新生儿气胸	12	90～92	正常
患儿15	新生儿肺炎	12	90～94	卵圆孔未闭
患儿16	新生儿败血症	12	91～95	正常
患儿17	新生儿气胸	12	93～95	正常
患儿18	新生儿肺炎	12	87～87	卵圆孔未闭
患儿19	新生儿肺炎	12	86～90	正常
患儿20	新生儿肺炎	12	85～88	动脉导管未闭
患儿21	新生儿败血症	12	90～91	正常
患儿22	新生儿肺炎	12	89～92	卵圆孔未闭
患儿23	新生儿肺炎	12	88～90	卵圆孔未闭
患儿24	新生儿败血症	48	94～94	动脉导管未闭
患儿25	新生儿肺炎	48	88～89	正常
患儿26	新生儿肺炎	48	88～90	动脉导管未闭
患儿27	新生儿肺炎	48	90～91	正常
患儿28	新生儿肺炎	48	89～92	正常

表2 本研究28例非心脏因素所致低氧血症的脉搏血氧饱和度筛查结果呈阳性患儿病例资料

编号	诊断	生后SpO₂筛查结果呈阳性的时间(h)	SpO₂(%，最小值～最大值)	超声心动图检查结果
患儿1	新生儿肺炎	12	88～92	动脉导管未闭
患儿2	新生儿肺炎	12	89～90	正常
患儿3	新生儿肺炎	12	92～94	正常
患儿4	新生儿肺炎	12	91～94	正常
患儿5	新生儿败血症	12	91～93	卵圆孔未闭
患儿6	新生儿气胸	12	93～94	动脉导管未闭
患儿7	新生儿肺炎	12	90～93	房间隔缺损(3 mm)
患儿8	新生儿肺炎	12	91～91	正常
患儿9	新生儿肺炎	12	87～89	卵圆孔未闭
患儿10	新生儿肺炎	12	84～86	正常
患儿11	新生儿肺炎	12	91～92	动脉导管未闭
患儿12	新生儿湿肺	12	90～93	正常
患儿13	新生儿败血症	12	88～90	动脉导管未闭
患儿14	新生儿气胸	12	90～92	正常
患儿15	新生儿肺炎	12	90～94	卵圆孔未闭
患儿16	新生儿败血症	12	91～95	正常
患儿17	新生儿气胸	12	93～95	正常
患儿18	新生儿肺炎	12	87～87	卵圆孔未闭
患儿19	新生儿肺炎	12	86～90	正常
患儿20	新生儿肺炎	12	85～88	动脉导管未闭
患儿21	新生儿败血症	12	90～91	正常
患儿22	新生儿肺炎	12	89～92	卵圆孔未闭
患儿23	新生儿肺炎	12	88～90	卵圆孔未闭
患儿24	新生儿败血症	48	94～94	动脉导管未闭
患儿25	新生儿肺炎	48	88～89	正常
患儿26	新生儿肺炎	48	88～90	动脉导管未闭
患儿27	新生儿肺炎	48	90～91	正常
患儿28	新生儿肺炎	48	89～92	正常

表3 本研究6例脉搏血氧饱和度筛查结果呈阳性的危重型先天性心脏病患儿病例资料

编号	生后SpO₂筛查结果呈阳性的时间(h)	SpO₂(%，最小值～最大值)	超声心动图检查结果	编号	生后SpO₂筛查结果呈阳性的时间(h)	SpO₂(%,最小值～最大值)	超声心动图检查结果
患儿1	12	90～92	肺动脉闭锁	患儿4	12	89～90	肺动脉闭锁
患儿2	12	83～85	完全性大动脉转位	患儿5	12	88～89	肺动脉闭锁
患儿3	12	87～88	主动脉弓离段	患儿6	48	89～93	肺动脉狭窄合并室间隔缺损

表3 本研究6例脉搏血氧饱和度筛查结果呈阳性的危重型先天性心脏病患儿病例资料

编号	生后SpO₂筛查结果呈阳性的时间(h)	SpO₂(%，最小值～最大值)	超声心动图检查结果	编号	生后SpO₂筛查结果呈阳性的时间(h)	SpO₂(%,最小值～最大值)	超声心动图检查结果
患儿1	12	90～92	肺动脉闭锁	患儿4	12	89～90	肺动脉闭锁
患儿2	12	83～85	完全性大动脉转位	患儿5	12	88～89	肺动脉闭锁
患儿3	12	87～88	主动脉弓离段	患儿6	48	89～93	肺动脉狭窄合并室间隔缺损

[1]	Plana MN, Zamora J, Suresh G, et al. Pulse oximetry screening for critical congenital heart defects[J]. Cochrane Database Syst Rev, 2018, 3: CD011912.
[2]	Kemper AR, Lam WKK, Bocchini JA Jr. The success of state newborn screening policies for critical congenital heart disease[J]. JAMA, 2017, 318(21): 2087-2088.
[3]	Ewer AK. Pulse oximetry screening for critical congenital heart defects in newborn infants: should it be routine？[J]. Arch Dis Child Fetal Neonatal Ed, 2014, 99(1): F93-F95.
[4]	Oster ME, Aucott SW, Glidewell J, et al. Lessons learned from newborn screening for critical congenital heart defects[J]. Pediatrics, 2016, 137(5): e20154573.
[5]	邵肖梅，叶鸿瑁，丘小汕. 实用新生儿学[M]. 4版. 北京：人民卫生出版社，2012: 340-347, 401-408.
[6]	Kochilas LK, Lohr JL, Bruhn E, et al. Implementation of critical congenital heart disease screening in Minnesota[J]. Pediatrics, 2013, 132(3): e587-e594.
[7]	Hamid MA, Chandna A, Siddiqui S, et al. Pulse oximetry: a reliable and cost effective screening tool in children with pneumonia for developing countries[J]. J Pak Med Assoc, 2016, 66(8): 1015-1018.
[8]	Jawin V, Ang HL, Omar A, et al. Beyond critical congenital heart disease: newborn screening using pulse oximetry for neonatal sepsis and respiratory diseases in a middle-income country[J]. PLoS One, 2015, 10(9): e0137580.
[9]	Floyd J, Wu L, Hay Burgess D, et al. Evaluating the impact of pulse oximetry on childhood pneumonia mortality in resource-poor settings[J]. Nature, 2015, 528(7580): S53-S59.
[10]	Alwadhi V, Dewan P, Malhotra RK, et al. Tachypnea and other danger signs vs pulse oximetry for prediction of hypoxia in severe pneumonia/very severe disease[J]. Indian Pediatr, 2017, 54(9): 729-734.
[11]	Mortensen N, Augustsson JH, Ulriksen J, et al. Early warning- and track and trigger systems for newborn infants: a review[J]. J Child Health Care, 2017, 21(1): 112-120.
[12]	King C, Boyd N, Walker I, et al. Opportunities and barriers in paediatric pulse oximetry for pneumonia in low-resource clinical settings: a qualitative evaluation from Malawi and Bangladesh[J]. BMJ Open, 2018, 8(1): e019177.
[13]	Diller CL, Kelleman MS, Kupke KG, et al. A modified algorithm for critical congenital heart disease screening using pulse oximetry[J]. Pediatrics, 2018, 141(5): e20174065.
[14]	Grosse SD, Peterson C, Abouk R, et al. Cost and cost-effectiveness assessments of newborn screening for critical congenital heart disease using pulse oximetry：a review[J]. Int J Neonatal Screen, 2017, 3(4): 34.
[15]	Zhao QM, Ma XJ, Ge XL, et al. Pulse oximetry with clinical assessment to screen for congenital heart disease in neonates in China: a prospective study[J]. Lancet, 2014, 384(9945): 747-754.

[1]	Fei Dai, Bowen Zhao, Mei Pan, Xiaohui Peng, Ran Chen, Yuanshi Tian, Ming Di. Value of multiple fetal echocardiographic quantitative parameters in assessing heart structure and function in fetuses with coarctation of the aorta[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(10): 950-958.
[2]	Zhong Yang, Jingye Shi, Xuedong Deng, Wei Jiang, Linliang Yin, Qi Pan, Hong Liang, Jianfang Ma, Zhenqi Wang, Jun Zhang, Shanshan Dong. Diagnostic value of prenatal ultrasound in fetal 22q11.2 microdeletion syndrome[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(09): 852-858.
[3]	Panpan Zhang, Bowen Zhao, Mei Pan, Xiaohui Peng, Ran Chen, Yuanshi Tian, Xianfang Lin, Shanshan Hui, Tingting Shen. Application value of post-left atrium space index in fetuses with absent pulmonary valve syndrome[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(04): 391-398.
[4]	Lie Zhang, Yihe Yan, Jieyu Du. Predictive efficacy of secretory leukocyte protease inhibitor in severe pneumonia patients with non-invasive ventilation[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2024, 17(04): 301-306.
[5]	Juan Gao, Feng Zheng, Qing Zhang, Linna Zhu, Xian Wang. Comparative study of three common clinical indexes in fluid management of patients with severe pneumonia[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2024, 17(03): 204-210.
[6]	Meng Wang, Hualin Wang, Jian Wang, Kun Sun. Current research status and prospect on intrauterine diagnosis and treatment of congenital heart disease[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 481-485.
[7]	Shijie Li, Chuan′an Shen. Research status of ventilator-associated pneumonia in burn patients with inhalation injury[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2024, 19(04): 351-355.
[8]	Shengwei Zhang, Zhaolu Meng, Shisen Wan, Peng Yan, Qiao Yang. A case of Mycoplasma pneumoniae-induced reactive infectious mucocutaneous eruption[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2024, 18(05): 309-313.
[9]	Baoying Zheng, Xiaolan Huang, Nan Jia, Chunmei Zhu. Early warning indicators of children with refractory mycoplasma pneumoniae pneumonia[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2024, 18(04): 215-221.
[10]	Baoping Xu, Huaiwen Peng, Huaibin Yu, Xiaotao Wang. A case of diabetic ketoacidosis with hepatic portal vein gas secondary to corona virus disease 2019[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2024, 18(04): 250-255.
[11]	Shuangxing Wang, Yongjie Wu, Bing Meng, Hongtao Zhang, Mei Diao, Hui Zhang. Combined minimally invasive incision and laparoscopy for simultaneous treatment of congenital heart disease with extracardiac anomalies[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2024, 17(04): 244-249.
[12]	Changchun Cong, Chunlin Wang, Xiaogang Wu, Jinbiao Wang, Fubin Zhang, Lei Sun, Li Wang. Risk factors and etiology of ventilator-associated pneumonia in patients with severe traumatic brain injury[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2024, 10(03): 151-157.
[13]	Dongxing Yang, Peng Shen, Huiying Zhao. A case of severe acute respiratory distress syndrome complicated by Guillain-Barré syndrome treated with immunoglobulin combined with Eculizumab[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2024, 10(04): 404-408.
[14]	Wei Duan, Fei Liu, Guangyuan Xu, Yuhao Cheng, Xing Chen. Effect of different dosimetric parameters of intensity modulated radiotherapy plans for esophageal cancer on the occurrence and severity of radiation pneumonia[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(04): 320-324.
[15]	Jingni Xi, Na Li, Qi Zhang. Predictive value of neutrophil-to-lymphocyte ratio for progression of severe community-acquired pneumonia to sepsis in elderly patients[J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2024, 11(03): 28-31.

Viewed

Full text

Abstract

Please choose a citation manager

Content to export