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The impact of altitude on screening for critical congenital heart disease

Journal of Perinatology volume 38, pages 530–536 (2018)Cite this article

Subjects

Abstract

Objectives

The objectives were to determine the frequency with which pulse oximetry identifies critical congenital heart defects in asymptomatic full-term and late preterm newborns using the AAP expert panel algorithm in a variety of different hospital settings and to evaluate the impact of altitude on the rate of positive screens.

Methods

We conducted a prospective clinical study of implementation of a newborn pulse oximetry screening for congenital heart disease in 34 independent hospitals. Infants were eligible for enrollment if their gestational age was 35–44 weeks.

Results

Of the 34 sites which enrolled infants into our study, 24 were located at or below 2000 feet; 5 were located between 4700 and 6000 feet and 5 were located above 6000 feet in altitude. We screened 6109 infants; 65 (1.1%) had a positive screen. There were no differences in median gestational age, birth weight, mode of delivery or race/ethnicity for infants with a positive screen compared to infants with a negative screen. Infants with positive screens were more often male and more often born at sites located at high altitudes. The frequency of a positive screen increased from 0.2% for infants born at sites at or less than 2000 feet to 6% for sites located above 6000 feet. We stopped enrollment at the site located at 8163 feet after enrolling 65 infants because 23 (35%) were positive.

Conclusions

Screening infants for critical cardiac defects at altitude is complicated by the increased false positive screens.

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Acknowledgements

Principal investigators were as follows: Kaashif Aqeeb Ahmad, Methodist Children’s Hospital (San Antonio, TX); Jennifer Anderson, Presbyterian Hospital (Albuquerque, NM); Travis W. Anschutz, Eastern Idaho Regional Medical Center (Idaho Falls, ID); Martin Anyebuno, Swedish American Hospital (Rockford, IL); James Berger, Ogden Regional Medical Center (Ogden, UT); G. Michael Bixler, Miami Valley Hospital (Dayton, OH); Jeffrey M. Brown, Vail Valley Medical Center (Vail, CO); Edward Co, Integris Baptist Medical Center (Oklahoma City, OK); Delphine M. Eichorst, Rocky Mountain Hospital for Children at Presbyterian/St. Luke’s Medical Center (Denver, CO); Jenelle Ferry, Mease Countryside Hospital (Safety Harbor, FL) and Morton Plant Hospital (Clearwater, FL); Oluwamayowale Folaranmi, PinnacleHealth Harrisburg Hospital (Harrisburg, PA); Adrian Garcia, Memorial Hermann The Woodlands Hospital (The Woodlands, TX); Claudia Hart, Flagstaff Medical Center (Flagstaff, AZ); Michael T. Hinkes, Northside Hospital (Atlanta, GA); Mary R. Laird, UCHealth at Memorial Hospital Central and Memorial Hospital North (Colorado Springs, CO); Kartik Mody, St. Joseph’s Hospital & Medical Center (Phoenix, AZ); Stephen T. Moffitt, Capital Health Regional Medical Center (Trenton, NJ); Kay Mohsini, Covenant Medical Center (Saginaw, MI); Maria Imelda Bautista-Navarro, Stormont Vail Regional Health Center (Topeka, KS); Michael S. Paranka, The Medical Center of Aurora (Aurora, CO) and Sky Ridge Medical Center (Lone Tree, CO); Jay A. Patel, Banner Good Samaritan Medical Center (Phoenix, AZ); George C. Powers, The Children’s Hospital of San Antonio (San Antonio, TX); Isabel Basaldu-Prado, St. Luke’s Baptist Hospital (San Antonio, TX); Andres Rodriguez, Broward Health Coral Springs (Coral Springs, FL); Elaine M. Sillos, Presbyterian Hospital (Albuquerque, NM); Susan F. Townsend, Memorial Hospital North (Colorado Springs, CO); Lakshmy Vaidyanathan, Seton Medical Center (Austin, TX); Mary Wearden, North Central Baptist Hospital (San Antonio, TX); David Weisoly, Baylor Scott & White Medical Center-Carrollton (Carrollton, TX); Robert D. White, Elkhart General Hospital (Elkhart, IN). Contributors were as follows: Carol Beck, The Medical Center of Aurora (Aurora, CO); Janna Benston, Northside Hospital (Atlanta, GA); Lesli Blanchard, Eastern Idaho Regional Medical Center (Idaho Falls, ID); Abigail Bye, Swedish American Hospital (Rockford, IL); Julie Clowers, Baylor Scott & White Medical Center-Carrollton (Carrollton, TX); Nancy Fraire, UCHealth at Memorial Hospital Central (Colorado Springs, CO); Juliet Garbow, Covenant HealthCare (Saginaw, MI); Katrina Grier, Northside Hospital (Atlanta, GA); Jacqueline Hoffman, Mease Countryside Hospital (Safety Harbor, FL) and Morton Plant Hospital (Clearwater, FL); Monica Jaynes, Baylor Scott & White Medical Center-Carrollton (Carrollton, TX); Charmaine Kathen, Methodist Children’s Hospital (San Antonio, TX); Sue Mackey, Miami Valley Hospital (Dayton, OH); Stephanie Mahan, The Children’s Hospital of San Antonio (San Antonio, TX); Debra McCann, Integris Baptist Medical Center (Oklahoma City, OK); Becky Micetic, Banner - University Medical Center Phoenix (Phoenix, AZ); Cathryn Moody, Memorial Hermann The Woodlands Hospital (The Woodlands, TX); Jamie K. Phelan, Sky Ridge Medical Center (Lone Tree, CO); Barbara Ritter, PinnacleHealth Harrisburg Hospital (Harrisburg, PA); Kathy Roper, Vail Valley Medical Center (Vail, CO); Janet Rosebrough, Stormont Vail Regional Health Center (Topeka, KS); Steve Smith, Ogden Regional Medical Center (Ogden, UT); Crystal Tolbert, Sacred Heart Hospital – Pensacola (Pensacola, FL); Delores Troyer, Elkhart General Hospital (Elkhart, IN); Christine Wade, Banner - University Medical Center Phoenix (Phoenix, AZ). We also acknowledge Alex R. Kemper for helping with study design and for reviewing the manuscript and offering important edits. Administrative support was as follows: Carole Benson, Jaclyn Cohen, Nalina Fisher, Theresa Katich, Kathy McCarty, Octavia Reed, Vernice Vixamar and Shannon Weeks.

Author contributions

MSP, JMB, MVP and RHC contributed to the conception and design of the study and provided extensive editorial input into the final paper. RHC wrote the first draft, and managed edits provided by the co-authors of the manuscript. ASK managed the monitoring and conduct of the study protocol and contributed to the drafting and revision of the article for important intellectual content. RDW contributed to the conception and design and interpretation of data, and critical revisions for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Funding

This work was supported by Pediatrix Medical Group. No outside honorarium, grant, or other form of payment was given to anyone to produce the manuscript.

Author information

Authors and Affiliations

  1. Sky Ridge Medical Center, Lone Tree, Colorado, USA

    Michael S. Paranka

  2. Aurora Medical Center, Aurora, Colorado, USA

    Michael S. Paranka

  3. Vail Valley Medical Center, Vail, Colorado, USA

    Jeffrey M. Brown

  4. Memorial Hospital South Bend, South Bend, Indiana, USA

    Robert D. White

  5. Northwest Congenital Heart Care, Pediatrix, Cardiology, Tacoma, Washington, USA

    Matthew V. Park

  6. The MEDNAX Center for Research, Education Safety and Quality, Sunrise, Florida, USA

    Amy S. Kelleher & Reese H. Clark

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  1. Michael S. Paranka
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  2. Jeffrey M. Brown
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  4. Matthew V. Park
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  5. Amy S. Kelleher
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  6. Reese H. Clark
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Corresponding author

Correspondence to Reese H. Clark.

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The authors declare that they have no conflict of interest.

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Paranka, M.S., Brown, J.M., White, R.D. et al. The impact of altitude on screening for critical congenital heart disease. J Perinatol 38, 530–536 (2018). https://doi.org/10.1038/s41372-018-0043-9

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