Critical Congenital Heart Defects before Discharge

Heart Defects of Congenital

The Timing of the Newborn Pulse Oximetry Screenings for the Critical Congenital Heart Defects before Discharge is a research study by Crouch et al with the objective of determining if there would be positive results derived from the second pulse oximetry screening (POS) completed for the newborns at 28 to hours of age. Also, these researchers had the aim of identifying if POS can be completed at 24 to 25 hours of age. In the introduction, they explain that the critical congenital heart defects (CCHD) account for 6 to 10% of the deaths among the newborn children. Moreover, they state that the seven main CCHD’s are the total anomalous pulmonary venous retum, tetralogy of Fallot, pulmonary atresia, hypoplastic left heart syndrome, truncus arteriosus, as well as the triscuspid atresia. All these diseases account for approximately 17 to 31% of the congenital heart diseases (CHDs). According to the research study, 8 in every 1000 infants are born with CHD (Crouch et al., 2016).

Crouch et al. conducted a search in the PubMed National Center for the Biotechnology Information Bookshelf, the Nurse Proquest databases as well as Medline utilizing the search terms pulse oximetry, CCHD screening, CCHD, Newborn Screening and Infant. According to their literature search, they established that there were no articles under which the researchers made a comparison of the outcomes within 24 hours versus the discharge up to the age of 48 hours. About the design and the participants under the methodology, the prospective descriptive study was reviewed by the institutional board from the hospital under the research. The inclusion criteria was gestational age above 35 weeks, parents with the ability to communicate English, and the provision of informed consent.

About the findings of the research, there were no positive POS results. Also, there were no extra diagnostic tests, which were ordered as derived from POS. Focusing on the RNs reported on the newborn physical conditions, 28 tests were completed on 14 newborns inclusive of laboratory testing with 7, ultrasound imaging (1), electrocardiograms (9), as well as chest x-ray imaging (8). Out of 1002 newborns who were screened, it was established that 0.5% had some cardiac anomalies with four infants having CHDs. Also, it was found that two patients (0.2%) with patent ductus arteriosus needed a follow-up from the healthcare provider. Moreover, false positive results were reported by the researchers with variation from 0.13% to 0.87% (Crouch et al., 2016).

Analysis of Heart Problems

Crouch et al. had good background of the research study because they found the literature associated with their topic of study after searching from various nursing databases. For instance, they analyzed the findings of derived from the Advisory Committee on Heritable Disorders in Children and Newborns with a strong support from the American Academy of Pediatrics and the American Heart Association. Also, they examined weaknesses from the past research studies under which the health care resources utilized to screen and evaluate in infants for the CCHD outweighed the costs for late detection, as well as deaths such as in Mahle et al. in 2009. Another strength of this study was the ability of the researchers close to the period of discharge but not after the 48 hours. This strategy helped them to detect the additional postductal heart anomalies and CCHD. They established the concerns in the previous year where eight infants were transferred to the level III NICU with four requiring immediate surgery. They stated that the health care resources may not be available when required or the relationship between echocardiogram readings and the pediatric cardiologists may not be in place, and therefore, affecting the outcomes of the intervention. By establishing the weaknesses of the previous studies, Crouch et al. had strong foundation of undertaking the research on the Timing of the Newborn Pulse Oximetry Screenings for the Critical Congenital Heart Defects before Discharge.

Focusing on the methodology of the research study, the design and the participants used were approved by the institution with clear procedure including the Registered Nurses (RNs) in all the sessions to examine its objectives. Also, they followed the hospital policy for the POS inclusive of the state’s algorithm after the nurse and the pediatric assessment. However, regardless of utilizing the right procedures, there were weaknesses in the sample used 1002 for all point of screening outcomes. They should have increased the sample size to over 2000 and distributed their source of data from different hospitals across the United States. Using a small sample size can be one of the reasons why false positive results were found in the research study. There was only one exclusion criterion was the known diagnosis of the cardiac and pulmonary complications, as well as other comorbidities. The researchers could have included other exclusion criteria to make the findings more defined. Based on the format of the research study, others, which are related to it, have their weaknesses stated. However, this is not the case, an act that may affect the findings in future.

References

Crouch, L., Speroni, K. G., Jones, R. A., MacDougall, E. P., & Daniel, M. G. (2016). Timing of Newborn Pulse Oximetry Screenings for Critical Congenital Heart Defects Before Discharge.