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A new algorithm DEtectS critical Congenital Heart Disease at different altitudes: ANDES-CHD study

Journal of Perinatology volume 44, pages 373–378 (2024)Cite this article

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Abstract

Background

Neonatal pulse oximetry screening (POS) algorithms for critical congenital heart disease (CCHD) have contributed towards decreasing neonatal mortality but cannot be applied at high altitudes. New POS algorithms at high altitudes are needed.

Methods

This observational, prospective study included newborns born at different altitudes from 0 to 4380 meters above the sea level in Peru. Healthy newborns underwent neonatal preductal and postductal oximetry, echocardiography and telephonic follow-up up to 12 months of age. Newborns with CCHD underwent preductal and postductal oximetry at the time of telemedicine evaluation while located at the high-altitude hospital where they were born, and their diagnoses were confirmed with echocardiography locally or after arriving to the referral center. Two new algorithms were designed using clinically accepted neonatal oximetry cutoffs or the 5th and 10th percentiles for preductal and postductal oximetry values.

Results

A total of 502 healthy newborns and 15 newborns with CCHD were enrolled. Echocardiography and telephonic follow-up were completed in 227 (45%) and 330 healthy newborns (65%), respectively. The algorithm based on clinically accepted cutoffs had a sensitivity of 92%, specificity of 73% and false positive rate of 27% The algorithm based on the 5th and 10th percentiles had a sensitivity of 80%, specificity of 88% and false positive rate of 12%.

Conclusions

Two algorithms that detect CCHD at different altitudes had adequate performance but high false positive rates.

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Fig. 1: Pulse oximetry values among health newborns and newborns with critical congenital heart disease (CCHD).
Fig. 2: ANDES CHD algorithm for high altitudes.
Fig. 3: ANDES CHD algorithm for very high altitudes.
Fig. 4: Algorithm using 5th and 10th percentiles from 0 to 4500 masl.

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Data availability

The datasets generated during the current study are available from the corresponding author on reasonable request.

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Funding

This study was supported by the University of California, Los Angeles Global Health Seed Grant 2021.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine. Mayo Clinic, Jacksonville, FL, USA

    Katia Bravo-Jaimes & Zhuo Li

  2. Wyckoff Heights Medical Center, New York, NY, USA

    Tania Vasquez-Loarte

  3. Florida Center for Allergy and Asthma Care, Florida, FL, USA

    Jose Rojas-Camayo

  4. Instituto Nacional de Salud del Niño de San Borja, Lima, Peru

    Monica Medina

  5. Universidad de Huanuco, Huanuco, Peru

    Christian R. Mejia

  6. University of Florida at Jacksonville, Florida, FL, USA

    Henry Zapata-Galarza

  7. Hospital Nacional Alberto Sabogal Sologuren, Callao, Peru

    Marilia Berrocal & Jeanette Orozco

  8. Universidad Continental, Junin, Peru

    Daniel Lozano & Maryuri Santivañez

  9. Hospital Regional de Cajamarca, Cajamarca, Peru

    Carlos Sangay

  10. Hospital EsSalud II Pasco, Cerro de Pasco, Peru

    William Rosales

  11. Hospital EsSalud III Juliaca, Puno, Peru

    Leddy Mamani & Nelly Macedo

  12. Universidad Nacional Mayor de San Marcos, Lima, Peru

    Joel Coronado

  13. Instituto Nacional Cardiovascular, Lima, Peru

    Gian Huaman & Rafael Marquez

  14. Department of Pediatrics, University of California, Los Angeles, CA, USA

    Kiran M. Masood

  15. Department of Pediatrics, Mattel Children´s Hospital, California, CA, USA

    Juan Alejos & Leigh Reardon

  16. Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, CA, USA

    Leigh Reardon & Jeannette Lin

Authors
  1. Katia Bravo-Jaimes
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  2. Tania Vasquez-Loarte
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  11. Carlos Sangay
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  12. William Rosales
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  13. Leddy Mamani
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  16. Gian Huaman
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  18. Zhuo Li
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  19. Kiran M. Masood
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  20. Juan Alejos
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  21. Leigh Reardon
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  22. Jeannette Lin
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Contributions

Katia Bravo-Jaimes conceptualized and designed the study, drafted the initial manuscript, coordinated and supervised data collection, and critically reviewed and revised the manuscript. Jose Rojas-Camayo, Leigh Reardon and Jeannette Lin conceptualized and designed the study, and critically reviewed and revised the manuscript. Tania Vasquez-Loarte, Christian R. Mejia and Henry Zapata-Galarza designed the data collection instruments and critically reviewed and revised the manuscript. Zhuo Li carried out the analyses and critically reviewed and revised the manuscript. Kiran Mitha and Juan Alejos critically reviewed and revised the manuscript. Monica Medina, Marilia Berrocal, Jeanette Orozco, Daniel Lozano, Maryuri Santivañez, Carlos Sangay, William Rosales, Leddy Mamani, Nelly Macedo, Joel Coronado, Gian Huaman, and Rafael Marquez coordinated and supervised data collection, and critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Katia Bravo-Jaimes.

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Bravo-Jaimes, K., Vasquez-Loarte, T., Rojas-Camayo, J. et al. A new algorithm DEtectS critical Congenital Heart Disease at different altitudes: ANDES-CHD study. J Perinatol 44, 373–378 (2024). https://doi.org/10.1038/s41372-024-01888-5

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