| Objective: To explore the best optimization program of screening congenital heart disease and demonstrate the incidence of congenital heart disease in Ningbo newborns.Methods: 1.A total of 48007 newborns in Ningbo women and children’s hospital from July 2011 to December 2015 were included in the screening test.Using pulse oximetry plus different clinical evaluation to screen them in sequence and gradually come to the conclusion of the best optimization program.2.3 month to 12 months follow-up was performed for all the newborns that have been screened,then we demonstrate the incidence of congenital heart disease in Ningbo newborns.Results:1.During July 2011 to December 2012,18352 newborns were screened by 7 indicators.Of 246 positive-screened newborns,109 had CHD,sensitivity,specificity,FPR,PPV and NPR of 7 indicators for detecting all CHD and CCHD were 63.74%/86.67%,99.25%/98.73%,0.75%/ 1.27%,44.31%/5.28%,99.66%/99.99% respectively,and we found three best indicators: POX<95%,particular facial features and heart murmur.2.During January 2013 to June 2014,13041 newborns were screened by 3 indicators(POX plus heart murmur and particular facial features).Of 125 positive-screened newborns,73 had CHD,sensitivity,specificity,FPR,PPV and NPR of 3 indicators for detecting all CHD and CCHD were 62.93%/90.91%,99.60%/99.12%,0.40%/0.88%,58.40%/8.00%,99.67%/99.99%,respectively.POX plus heart murmur had the same sensitivity as that of all 3 indicators for detecting CHD but lower false positive rate.3.During July 2014 to December 2015,16614 newborns were screened by 2 indicators(POX plus heart murmur).Of 131 positive-screened newborns,97 had CHD,sensitivity,specificity,FPR,PPV and NPR of 7 indicators for detecting all CHD and CCHD were 62.58%/92.86%,99.79%/ 99.29%,0.21%/0.71%,74.05%/9.92%,99.65%/99.99%,respectively.4.Of 48007 screened newborns,442 had CHD,the incidence of CHD in this region is 0.92%.The most three common types of congenital heart disease were ventricular septal defect,patent ductus arteriosus and atrial septal defect(192(43.44%)vs.111(25.11%)vs.95(21.49%),respectively),which occupies 90.05% of all CHD.Of 442 CHD,402 had common CHD and 40 had CCHD,occupies 90.95% and 9.05% of all CHD,and the incidence of all newborns is 0.84% and 0.08% respectively.5.Gestational age,birth weight,degree of mothers,diseases of mothers or families,single birth/twins affect the incidence of CHD.Gender and town/village do not affect the incidence of CHD.6.Till December June,3~12 month follow-up visit demonstrates that the self healing rate of VSD was 23.44%,the self healing rate of PDA was 32.43%,the self healing rate of ASD was 31.58%,and the total self healing rate of CHD was 25.11%.The sequence of self healing is: PDA,ASD,VSD.Conclusion:1.The program of 2 indicators(POX <95%plus heart murmur)is significant and effective for the early detection of newborns with congenital heart diseases and it could take the place of the program of 7 indicators or 3indicators for the same meaningful sensitivity,better specificity,and lower NPR.2.The incidence of congenital heart disease in Ningbo is 0.92%,a little higher than the average level.3.VSD had the highest incidence of CHD,and PDA,ASD placed second and third.Big VSD combined with big ASD and TOF had the highest incidence of CCHD.Premature birth,low birth weight,higher degree of mothers,diseases of mothers or families,twins are the risk factors to incidence of CHD.4.Total self healing rate of congenital heart disease in Ningbo is 25.11%.There are many factors that affect the self healing rate of CHD,our data showed that the sequence is: PDA,ASD,VSD. |
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